Provider Demographics
NPI:1013953801
Name:SHARP HEALTHCARE
Entity Type:Organization
Organization Name:SHARP HEALTHCARE
Other - Org Name:SHARP REES STEALY PHARMACY
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:PO BOX 122166
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91912-6866
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5525 GROSSMONT CENTER DR
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3009
Practice Address - Country:US
Practice Address - Phone:619-644-6650
Practice Address - Fax:619-644-1205
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHARP HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-21
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY432283336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFLU011DOtherMEDICARE
CAPHA432280Medicaid
1990836OtherPK