Provider Demographics
NPI:1558957910
Name:SHARROW, NICKY (RPH)
Entity Type:Individual
Prefix:
First Name:NICKY
Middle Name:
Last Name:SHARROW
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2333 SAINT ALBERT THE GREAT DR
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-3715
Mailing Address - Country:US
Mailing Address - Phone:608-576-7407
Mailing Address - Fax:
Practice Address - Street 1:4639 HAMMERSLEY RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-2706
Practice Address - Country:US
Practice Address - Phone:608-223-7950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14942-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist