Healthcare Provider Details

I. General information

NPI: 1245579473
Provider Name (Legal Business Name): ROOSEVELT SHARPE JR. RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2013
Last Update Date: 02/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11406 CLASSICAL LN
SILVER SPRING MD
20901-5023
US

IV. Provider business mailing address

11406 CLASSICAL LN
SILVER SPRING MD
20901-5023
US

V. Phone/Fax

Practice location:
  • Phone: 301-681-9217
  • Fax:
Mailing address:
  • Phone: 301-467-3747
  • Fax: 301-576-5319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHA23075
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: