Provider Demographics
NPI:1063744332
Name:SOOKRAM, DROU
Entity type:Individual
Prefix:DR
First Name:DROU
Middle Name:
Last Name:SOOKRAM
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 1:200 DUTCH MEADOWS LN
Mailing Address - Street 2:
Mailing Address - City:GLENVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12302-3519
Mailing Address - Country:US
Mailing Address - Phone:518-344-7632
Mailing Address - Fax:
Practice Address - Street 1:200 DUTCH MEADOWS LN
Practice Address - Street 2:
Practice Address - City:GLENVILLE
Practice Address - State:NY
Practice Address - Zip Code:12302-3519
Practice Address - Country:US
Practice Address - Phone:518-344-7632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-11
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053640183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist