Provider Demographics
NPI:1205113644
Name:STEWART, SANDRA LYNN (RPH)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:LYNN
Last Name:STEWART
Suffix:
Gender:
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55310 SAINT PAUL DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48042-2414
Mailing Address - Country:US
Mailing Address - Phone:248-895-1254
Mailing Address - Fax:
Practice Address - Street 1:3900 18 MILE RD
Practice Address - Street 2:
Practice Address - City:STERLING HTS
Practice Address - State:MI
Practice Address - Zip Code:48314-3826
Practice Address - Country:US
Practice Address - Phone:586-883-9131
Practice Address - Fax:586-883-9158
Is Sole Proprietor?:No
Enumeration Date:2011-11-14
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302028870183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist