Provider Demographics
NPI:1396282034
Name:SOOKRAJ, SATISH (PHARMACIST)
Entity type:Individual
Prefix:DR
First Name:SATISH
Middle Name:
Last Name:SOOKRAJ
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:831 ARIZONA AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-7321
Mailing Address - Country:US
Mailing Address - Phone:954-865-7489
Mailing Address - Fax:
Practice Address - Street 1:9050 BISCAYNE BLVD
Practice Address - Street 2:
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33138-3222
Practice Address - Country:US
Practice Address - Phone:305-751-6366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-19
Last Update Date:2019-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS59665183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS59665OtherBOARD OF PHARMACY LICENSE