Provider Demographics
NPI:1043511199
Name:STROKON, IRENE (RPH)
Entity Type:Individual
Prefix:MS
First Name:IRENE
Middle Name:
Last Name:STROKON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-5208
Mailing Address - Country:US
Mailing Address - Phone:925-945-3440
Mailing Address - Fax:925-945-3640
Practice Address - Street 1:600 S BROADWAY
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5208
Practice Address - Country:US
Practice Address - Phone:925-945-3440
Practice Address - Fax:925-945-3640
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-05
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 31544183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist