MEDICARE: PHARMACARXE OF STERLING HEIGHTS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	079480475	OTHER	NJ	D-U-N-S

General Provider Information

NPI Number	:	1114354164
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHARMACARXE OF STERLING HEIGHTS LLC

Provider Business Mailing Address
First Line	:	4135 15 MILE RD
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-5400
Country	:	US
Telephone Number	:	586-268-1888
Fax Number	:	586-268-1811

Provider Business Practice Location Address
First Line	:	4135 15 MILE RD
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-5400
Country	:	US
Telephone Number	:	586-268-1888
Fax Number	:	586-268-1811

Authorized Official
Title or Position	:	OWNER
Name	:	STEPHANIE SAKELLIS
Credential	:
Telephone Number	:	248-925-7103

Provider Enumeration Date	:	10/07/2013
Last Update Date	:	02/14/2019

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