Provider Demographics
NPI:1659832137
Name:SANKER, THERESA KAY
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:KAY
Last Name:SANKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12069 AUTUMN LAKES DR
Mailing Address - Street 2:
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63043-4923
Mailing Address - Country:US
Mailing Address - Phone:314-583-6386
Mailing Address - Fax:
Practice Address - Street 1:12069 AUTUMN LAKES DR
Practice Address - Street 2:
Practice Address - City:MARYLAND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63043-4923
Practice Address - Country:US
Practice Address - Phone:314-583-6386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-27
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPH043170183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist