Provider Demographics
NPI:1720522394
Name:AFKN LLC
Entity Type:Organization
Organization Name:AFKN LLC
Other - Org Name:STERLING HEIGHTS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:NICK
Authorized Official - Middle Name:
Authorized Official - Last Name:GASSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-983-9740
Mailing Address - Street 1:38924 DEQUINDRE RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-2890
Mailing Address - Country:US
Mailing Address - Phone:586-983-9740
Mailing Address - Fax:586-999-5089
Practice Address - Street 1:38924 DEQUINDRE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-2890
Practice Address - Country:US
Practice Address - Phone:586-983-9740
Practice Address - Fax:586-999-5089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-15
Last Update Date:2022-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010110823336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2167179OtherPK