Healthcare Provider Details

I. General information

NPI: 1942166624
Provider Name (Legal Business Name): STELLAMARIS EMENIKE PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2025
Last Update Date: 12/26/2025
Certification Date: 12/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5091 US 41 S
HARVEY MI
49855-9001
US

IV. Provider business mailing address

511 CASTLE DR APT C
BALTIMORE MD
21212-2319
US

V. Phone/Fax

Practice location:
  • Phone: 906-249-1441
  • Fax: 906-249-9850
Mailing address:
  • Phone: 240-971-6911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302418343
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: