Provider Demographics
NPI:1215335872
Name:SHARMA, SONIA (RPH)
Entity type:Individual
Prefix:
First Name:SONIA
Middle Name:
Last Name:SHARMA
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 1:1823 SW NEWPORT ISLES BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-4586
Mailing Address - Country:US
Mailing Address - Phone:772-873-3743
Mailing Address - Fax:
Practice Address - Street 1:1750 SW GATLIN BLVD
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-2777
Practice Address - Country:US
Practice Address - Phone:772-878-3022
Practice Address - Fax:772-878-3216
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-15
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS43130183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL032431100Medicaid