Provider Demographics
NPI:1528009602
Name:SHARP HEALTHCARE
Entity Type:Organization
Organization Name:SHARP HEALTHCARE
Other - Org Name:SHARP REES-STEALY PHARMACY #3
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO SHARP REES-STEALY
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HROUNTAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-262-6003
Mailing Address - Street 1:8695 SPECTRUM CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1489
Mailing Address - Country:US
Mailing Address - Phone:858-499-3025
Mailing Address - Fax:
Practice Address - Street 1:16899 W BERNARDO DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-1603
Practice Address - Country:US
Practice Address - Phone:858-521-2290
Practice Address - Fax:858-521-2004
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHARP HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-09
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY554573336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFLU011COtherMEDICARE
1999407OtherPK
CAPHA451060Medicaid
CAPHA432260Medicaid