Provider Demographics
NPI:1548696610
Name:PHELAN, SHARON LYNN (RPH)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:LYNN
Last Name:PHELAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 W JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:IL
Mailing Address - Zip Code:61550-1545
Mailing Address - Country:US
Mailing Address - Phone:309-263-2313
Mailing Address - Fax:
Practice Address - Street 1:1075 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:IL
Practice Address - Zip Code:61550-1545
Practice Address - Country:US
Practice Address - Phone:309-263-2313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-20
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-038628183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist