Provider Demographics
NPI:1689774739
Name:BLUM, SHARON SHIRA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:SHIRA
Last Name:BLUM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:SHARON
Other - Middle Name:SHIRA
Other - Last Name:LIEBERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:782 LANETT AVE
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-5514
Mailing Address - Country:US
Mailing Address - Phone:718-327-6992
Mailing Address - Fax:
Practice Address - Street 1:130 W KINGSBRIDGE RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-3904
Practice Address - Country:US
Practice Address - Phone:718-584-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20051277183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist