Provider Demographics
NPI:1114354164
Name:PHARMACARXE OF STERLING HEIGHTS LLC
Entity Type:Organization
Organization Name:PHARMACARXE OF STERLING HEIGHTS LLC
Other - Org Name:PHARMACARE OF STERLING HEIGHTS/ PHARMACARXE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SAKELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-925-7103
Mailing Address - Street 1:4135 15 MILE RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-5400
Mailing Address - Country:US
Mailing Address - Phone:586-268-1888
Mailing Address - Fax:586-268-1811
Practice Address - Street 1:4135 15 MILE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-5400
Practice Address - Country:US
Practice Address - Phone:586-268-1888
Practice Address - Fax:586-268-1811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-07
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1114354164Medicaid
NJ079480475OtherD-U-N-S