MEDICARE: MRS. SANDRA LYNN STEWART RPH

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	183500000X	Pharmacist	5302028870	MI

General Provider Information

NPI Number	:	1205113644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SANDRA LYNN STEWART RPH

Provider Business Mailing Address
First Line	:	55310 SAINT PAUL DR
Second Line	:
City	:	MACOMB
State	:	MI
Zip	:	48042-2414
Country	:	US
Telephone Number	:	248-895-1254
Fax Number	:

Provider Business Practice Location Address
First Line	:	3900 18 MILE RD
Second Line	:
City	:	STERLING HTS
State	:	MI
Zip	:	48314-3826
Country	:	US
Telephone Number	:	586-883-9131
Fax Number	:	586-883-9158

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2011
Last Update Date	:	03/18/2025

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