Provider Demographics
NPI:1881270965
Name:SOOKRAM, STEPHANIE (CPHT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:SOOKRAM
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6859 ATLAS ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78223-3190
Mailing Address - Country:US
Mailing Address - Phone:979-338-9199
Mailing Address - Fax:
Practice Address - Street 1:3227 SE MILITARY DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78223-3876
Practice Address - Country:US
Practice Address - Phone:210-247-0083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-20
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX217929183700000X
TX217969183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX217929OtherCPHT