Provider Demographics
NPI:1710272174
Name:SHARITZ, JACQUELYN B (MS, RPH)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:B
Last Name:SHARITZ
Suffix:
Gender:F
Credentials:MS, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1897 JOHN CALVIN AVE
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30337-2628
Mailing Address - Country:US
Mailing Address - Phone:404-766-0136
Mailing Address - Fax:
Practice Address - Street 1:3660 MARKETPLACE BLVD
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-5738
Practice Address - Country:US
Practice Address - Phone:404-267-0064
Practice Address - Fax:404-267-0064
Is Sole Proprietor?:No
Enumeration Date:2011-06-14
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH0014626183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist