Provider Demographics
NPI:1184952384
Name:PERALES-BROEKEMEIER, STEPHANIE (PHARM D)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:PERALES-BROEKEMEIER
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6103 FARINON DR
Mailing Address - Street 2:BUILDING VI, SUITE 600
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-3442
Mailing Address - Country:US
Mailing Address - Phone:210-694-9217
Mailing Address - Fax:210-694-9547
Practice Address - Street 1:6103 FARINON DR
Practice Address - Street 2:BUILDING VI, SUITE 600
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-3442
Practice Address - Country:US
Practice Address - Phone:210-694-9217
Practice Address - Fax:210-694-9547
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-27
Last Update Date:2009-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40092183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist