Provider Demographics
NPI:1235737842
Name:SARKIS, ALBERT G
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:G
Last Name:SARKIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15205 W GREENFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-1519
Mailing Address - Country:US
Mailing Address - Phone:262-796-2734
Mailing Address - Fax:262-796-2742
Practice Address - Street 1:15205 W GREENFIELD AVE
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-1519
Practice Address - Country:US
Practice Address - Phone:262-796-2734
Practice Address - Fax:262-796-2742
Is Sole Proprietor?:No
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14809-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI14809-40OtherLICENSE