Healthcare Provider Details

I. General information

NPI: 1598303612
Provider Name (Legal Business Name): SHARON DENISE CRENSHAW RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2019
Last Update Date: 05/16/2026
Certification Date: 05/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 GREGORY PL
JACKSONVILLE AR
72076-3211
US

IV. Provider business mailing address

103 GREGORY PL
JACKSONVILLE AR
72076-3211
US

V. Phone/Fax

Practice location:
  • Phone: 501-985-0822
  • Fax: 501-985-3610
Mailing address:
  • Phone: 501-985-0822
  • Fax: 501-985-3610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPD07484
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPD07484
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: