Provider Demographics
NPI:1881631703
Name:SHARP HEALTHCARE
Entity type:Organization
Organization Name:SHARP HEALTHCARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:8695 SPECTRUM CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1489
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:525 3RD AVE
Practice Address - Street 2:STE A
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-5616
Practice Address - Country:US
Practice Address - Phone:619-420-7120
Practice Address - Fax:619-420-1602
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHARP HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-31
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY432253336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA432250Medicaid
CAFLU011AOtherMEDICARE
1999323OtherPK