Provider Demographics
NPI:1982178232
Name:MASSEY, SHARON MOORE (RPH)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:MOORE
Last Name:MASSEY
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 1:254 WALNUT RD
Mailing Address - Street 2:
Mailing Address - City:SARDIS
Mailing Address - State:MS
Mailing Address - Zip Code:38666-3420
Mailing Address - Country:US
Mailing Address - Phone:662-292-2447
Mailing Address - Fax:
Practice Address - Street 1:254 WALNUT RD
Practice Address - Street 2:
Practice Address - City:SARDIS
Practice Address - State:MS
Practice Address - Zip Code:38666-3420
Practice Address - Country:US
Practice Address - Phone:662-292-2447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS07352183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist