Provider Demographics
NPI:1124300678
Name:HASTY, SHARON FOHL (RPH)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:FOHL
Last Name:HASTY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7501 CORINTH CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23437-9101
Mailing Address - Country:US
Mailing Address - Phone:757-562-2155
Mailing Address - Fax:757-562-2164
Practice Address - Street 1:12 E WINDSOR BLVD
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:VA
Practice Address - Zip Code:23487-9442
Practice Address - Country:US
Practice Address - Phone:757-242-6191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-11
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202005476183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist