Provider Demographics
NPI:1619957461
Name:ROBERTS, SHARON J (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:J
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5050 N NEVADA AVE
Mailing Address - Street 2:ATTN: COSTCO PHARMACY
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-8602
Mailing Address - Country:US
Mailing Address - Phone:719-264-5019
Mailing Address - Fax:719-264-5016
Practice Address - Street 1:5050 N NEVADA AVE
Practice Address - Street 2:ATTN: COSTCO PHARMACY
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-8602
Practice Address - Country:US
Practice Address - Phone:719-264-5019
Practice Address - Fax:719-264-5016
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202012857183500000X
GA19254183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0202012857OtherVA RPH LICENSE
GA19254OtherGA RPH LICENSE
FLPS45771OtherFLORIDA BOARD OF PHARMACY
COPHA.0020325OtherCOLORADO BOARD OF PHARMACY