Provider Demographics
NPI:1629532593
Name:PRESTIGE SPECIALTY PHARMACY 3
Entity Type:Organization
Organization Name:PRESTIGE SPECIALTY PHARMACY 3
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMRO
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARAFELDIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-800-8003
Mailing Address - Street 1:31700 VAN DYKE AVE STE C
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-7949
Mailing Address - Country:US
Mailing Address - Phone:586-800-8002
Mailing Address - Fax:
Practice Address - Street 1:31700 VAN DYKE AVE STE C
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-7949
Practice Address - Country:US
Practice Address - Phone:586-800-8003
Practice Address - Fax:586-883-9388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy