Healthcare Provider Details

I. General information

NPI: 1457503195
Provider Name (Legal Business Name): STEVEN J SUOKKO PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2008
Last Update Date: 10/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 WISCONSIN AVE PAIN MANAGEMENT CLINIC
RACINE WI
53403-1978
US

IV. Provider business mailing address

3801 SPRING ST PHARMACY DEPARTMENT
RACINE WI
53405-1667
US

V. Phone/Fax

Practice location:
  • Phone: 262-687-2635
  • Fax:
Mailing address:
  • Phone: 262-687-4308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13922-040
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: