Provider Demographics
NPI:1063908630
Name:THAKRAL, SUMMIT KUMAR
Entity type:Individual
Prefix:
First Name:SUMMIT
Middle Name:KUMAR
Last Name:THAKRAL
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 1:718 TYLER RUN
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-5192
Mailing Address - Country:US
Mailing Address - Phone:713-240-2653
Mailing Address - Fax:
Practice Address - Street 1:23500 BERRY PKWY
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-2509
Practice Address - Country:US
Practice Address - Phone:281-239-3731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-07
Last Update Date:2018-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62637183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist