Provider Demographics
NPI:1770862476
Name:PARKER, SHARON BROWN
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:BROWN
Last Name:PARKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 JOHN SMALL AVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-3759
Mailing Address - Country:US
Mailing Address - Phone:252-946-9631
Mailing Address - Fax:252-946-2234
Practice Address - Street 1:1020 JOHN SMALL AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-3759
Practice Address - Country:US
Practice Address - Phone:252-946-9631
Practice Address - Fax:252-946-2234
Is Sole Proprietor?:No
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10440183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0075077Medicaid