Provider Demographics
NPI:1578570156
Name:SAKSTRUP, DAVID P (RPH)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:P
Last Name:SAKSTRUP
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7210 N MAIN ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-1575
Mailing Address - Country:US
Mailing Address - Phone:248-625-3885
Mailing Address - Fax:248-625-3886
Practice Address - Street 1:7210 N MAIN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-1575
Practice Address - Country:US
Practice Address - Phone:248-625-3885
Practice Address - Fax:248-625-3886
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302027117183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5353100001Medicare ID - Type UnspecifiedPROVIDER NUMBER