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General NPI Number Information
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NPI Number | 1548750714
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Entity Type | Organization
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Legal Business Name | PRESTIGE SPECIALTY PHARMACY LLC
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Dates
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Enumeration Date | 05/14/2018
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Last Update Date | 06/05/2018
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Provider Practice Location Address
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Address Line | 3739 15 MILE RD
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City | STERLING HEIGHTS
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State | MI
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Zip | 48310
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Country | US
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Telephone | 877-742-7621
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Fax | 586-883-9388
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Provider Business Mailing Address
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Address Line | 3739 15 MILE RD
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City | STERLING HEIGHTS
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State | MI
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Zip | 48310
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Country | US
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Telephone | 877-742-7621
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Fax | 586-883-9388
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Authorized Official
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Title or Position | CEO
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Name | AMRO SHARAFELDIN
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Credential |
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Telephone | 877-742-7621
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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