Provider Demographics
NPI:1114264983
Name:SUKHRAM, SHAUN E
Entity Type:Individual
Prefix:DR
First Name:SHAUN
Middle Name:E
Last Name:SUKHRAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11109 WINTHROP MARKET ST
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-4252
Mailing Address - Country:US
Mailing Address - Phone:813-684-0169
Mailing Address - Fax:813-685-2304
Practice Address - Street 1:11109 WINTHROP MARKET ST
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-4252
Practice Address - Country:US
Practice Address - Phone:813-684-0169
Practice Address - Fax:813-685-2304
Is Sole Proprietor?:No
Enumeration Date:2013-01-13
Last Update Date:2013-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0045381183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist