Provider Demographics
NPI:1831470145
Name:MACMAHON, SHARON STEGALL (RPH)
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:STEGALL
Last Name:MACMAHON
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 1:1913 HIGHWAY 45 N
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-1950
Mailing Address - Country:US
Mailing Address - Phone:662-329-1766
Mailing Address - Fax:
Practice Address - Street 1:1913 HIGHWAY 45 N
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-1950
Practice Address - Country:US
Practice Address - Phone:662-329-1766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-31
Last Update Date:2024-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0015260183500000X
MST-16490183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist