Healthcare Provider Details

I. General information

NPI: 1134948441
Provider Name (Legal Business Name): STEPHANIE RENE BURCK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2024
Last Update Date: 10/04/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5627 UNIVERSITY HTS STE 108
SAN ANTONIO TX
78249-3583
US

IV. Provider business mailing address

5627 UNIVERSITY HTS STE 108
SAN ANTONIO TX
78249-3583
US

V. Phone/Fax

Practice location:
  • Phone: 855-427-4682
  • Fax:
Mailing address:
  • Phone: 855-427-4682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number53133
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: