Individual
SANDRA SOUVANNACHAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
2301 W KENOSHA ST, BROKEN ARROW, OK 74012-8912
(918) 259-9136
(918) 259-9141
Mailing address
2301 W KENOSHA ST, BROKEN ARROW, OK 74012-8912
(918) 259-9136
(918) 259-9141
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
15504
OK
Other
Enumeration date
11/03/2020
Last updated
11/03/2020
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