1740227289 NPI number — SHARP HEALTHCARE

Table of content: (NPI 1740227289)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740227289 NPI number — SHARP HEALTHCARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHARP HEALTHCARE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SHARP REES-STEALY PHARMACY #7
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740227289
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/06/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8695 SPECTRUM CENTER BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92123-1489
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 E PALOMAR ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHULA VISTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91913-1800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-397-3072
Provider Business Practice Location Address Fax Number:
619-397-3375
Provider Enumeration Date:
06/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HROUNTAS
Authorized Official First Name:
STACEY
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO SHARP REES-STEALY
Authorized Official Telephone Number:
858-262-6003

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PHY45222 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PHA452220 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: FLU011E . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1997966 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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