MEDICARE: BRENDA SUZANNE SHARP RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RPH021524	GA
2	183500000X	Pharmacist	PCT.0008366	CT

General Provider Information

NPI Number	:	1013290220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA SUZANNE SHARP RPH

Provider Business Mailing Address
First Line	:	4210 AUGUSTA RD
Second Line	:
City	:	GARDEN CITY
State	:	GA
Zip	:	31408-2106
Country	:	US
Telephone Number	:	912-964-4311
Fax Number	:	912-964-4358

Provider Business Practice Location Address
First Line	:	4210 AUGUSTA RD
Second Line	:
City	:	GARDEN CITY
State	:	GA
Zip	:	31408-2106
Country	:	US
Telephone Number	:	912-964-4311
Fax Number	:	912-964-4358

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2011
Last Update Date	:	09/23/2011

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