Provider Demographics
NPI:1073112785
Name:SHARP, DEBORAH LYNN
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LYNN
Last Name:SHARP
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 1:6616 FM 1488 RD
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-1399
Mailing Address - Country:US
Mailing Address - Phone:936-321-9870
Mailing Address - Fax:936-321-9872
Practice Address - Street 1:6616 FM 1488 RD
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-1399
Practice Address - Country:US
Practice Address - Phone:936-321-9870
Practice Address - Fax:936-321-9872
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30561183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist