Healthcare Provider Details

I. General information

NPI: 1740079847
Provider Name (Legal Business Name): JANE PEINE SHARP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2025
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1614 GLENN BLVD SW
FORT PAYNE AL
35968-3522
US

IV. Provider business mailing address

1614 GLENN BLVD SW
FORT PAYNE AL
35968-3522
US

V. Phone/Fax

Practice location:
  • Phone: 256-845-3402
  • Fax: 256-845-3289
Mailing address:
  • Phone: 256-845-3402
  • Fax: 256-845-3289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11437
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: