Provider Demographics
NPI:1548560055
Name:SUREK, STEVEN JOSEPH (RPH)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:JOSEPH
Last Name:SUREK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7788 REGENTS RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-1938
Mailing Address - Country:US
Mailing Address - Phone:858-455-6340
Mailing Address - Fax:858-455-1764
Practice Address - Street 1:7788 REGENTS RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-1938
Practice Address - Country:US
Practice Address - Phone:858-455-6340
Practice Address - Fax:858-455-1764
Is Sole Proprietor?:No
Enumeration Date:2010-10-31
Last Update Date:2010-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43905183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist