Healthcare Provider Details

I. General information

NPI: 1356824825
Provider Name (Legal Business Name): SHARONDA BEALER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2018
Last Update Date: 09/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1661 INTERNATIONAL PLACE DR STE 150
MEMPHIS TN
38120-1432
US

IV. Provider business mailing address

1661 INTERNATIONAL PLACE DR STE 150
MEMPHIS TN
38120-1432
US

V. Phone/Fax

Practice location:
  • Phone: 901-821-6729
  • Fax: 901-821-4929
Mailing address:
  • Phone: 901-821-6729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number0000028677
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: