Healthcare Provider Details

I. General information

NPI: 1669130084
Provider Name (Legal Business Name): STICKS R US LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2021
Last Update Date: 11/17/2022
Certification Date: 11/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 MARTIN BLVD STE 108
MIDDLE RIVER MD
21220-4103
US

IV. Provider business mailing address

1515 MARTIN BLVD STE 108
MIDDLE RIVER MD
21220-4103
US

V. Phone/Fax

Practice location:
  • Phone: 800-354-8935
  • Fax: 443-231-6767
Mailing address:
  • Phone: 800-354-8935
  • Fax: 443-231-6767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: VANESSA SABASTRO
Title or Position: OWNER
Credential:
Phone: 800-354-8935