Provider Demographics
NPI:1104061001
Name:SHARES, MAGDALEN (RPH)
Entity type:Individual
Prefix:MRS
First Name:MAGDALEN
Middle Name:
Last Name:SHARES
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:MAGGIE
Other - Middle Name:OKOJIE
Other - Last Name:SHARES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:2863 BRIDLE CREEK DR SW
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-5695
Mailing Address - Country:US
Mailing Address - Phone:678-520-6115
Mailing Address - Fax:
Practice Address - Street 1:2863 BRIDLE CREEK DR SW
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-5695
Practice Address - Country:US
Practice Address - Phone:678-520-6115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-05
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH015144183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist