Provider Demographics
NPI:1063939635
Name:CONEY, SHARON
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:CONEY
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 1:2303 HOWARD RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MS
Mailing Address - Zip Code:39095-8041
Mailing Address - Country:US
Mailing Address - Phone:601-750-9025
Mailing Address - Fax:662-247-3789
Practice Address - Street 1:520 N HAYDEN ST
Practice Address - Street 2:
Practice Address - City:BELZONI
Practice Address - State:MS
Practice Address - Zip Code:39038-3616
Practice Address - Country:US
Practice Address - Phone:662-247-3434
Practice Address - Fax:662-247-3679
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST-09114183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist