Provider Demographics
NPI:1073078325
Name:STAYWELL PHARMACY CORP
Entity Type:Organization
Organization Name:STAYWELL PHARMACY CORP
Other - Org Name:STAYWELL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SADATHULLA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAREEF
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:516-859-4292
Mailing Address - Street 1:912 E NORTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60074-6506
Mailing Address - Country:US
Mailing Address - Phone:847-496-5559
Mailing Address - Fax:847-496-5437
Practice Address - Street 1:912 E NORTHWEST HWY UNIT C-131
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60074-6506
Practice Address - Country:US
Practice Address - Phone:847-942-3110
Practice Address - Fax:847-496-5437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-31
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy