Provider Demographics
NPI:1013098383
Name:PROMBO, SHARON DENISE (PHARMD,)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:DENISE
Last Name:PROMBO
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 1:1004 WATERBURY CIR
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:IA
Mailing Address - Zip Code:50009-1092
Mailing Address - Country:US
Mailing Address - Phone:515-967-7896
Mailing Address - Fax:
Practice Address - Street 1:3501 8TH ST SW
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:IA
Practice Address - Zip Code:50009-1012
Practice Address - Country:US
Practice Address - Phone:515-967-1794
Practice Address - Fax:515-967-1892
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20178183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist