Provider Demographics
NPI:1891158440
Name:SEARS HOLDINGS CORPORATION
Entity Type:Organization
Organization Name:SEARS HOLDINGS CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:POKRASS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:480-452-9121
Mailing Address - Street 1:4100 52ND ST
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53144-3900
Mailing Address - Country:US
Mailing Address - Phone:262-658-0902
Mailing Address - Fax:
Practice Address - Street 1:4100 52ND ST
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144-3900
Practice Address - Country:US
Practice Address - Phone:262-658-0902
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-31
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18051-403336C0003X
IL0512991243336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy