Provider Demographics
NPI:1710393111
Name:ANDERSON, SHARINA N
Entity type:Individual
Prefix:
First Name:SHARINA
Middle Name:N
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 N 7TH ST
Mailing Address - Street 2:#500
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-5151
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2500 N 7TH ST
Practice Address - Street 2:#500
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-5151
Practice Address - Country:US
Practice Address - Phone:318-323-0133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-07
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPNT.046962390200000X
LAPST.021013183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program