Stephanie Kourtakis, PHARMD, BCACP

Primary specialty

Ambulatory Care PharmacistTaxonomy code 1835P2201X

License

RPH80480 Issued in CA

Practice address

26520 Cactus Ave
Moreno Valley, CA 92555-3927

Phone

(951) 486-4000

NPI assigned

Jan 3, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1578009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578009600000",
    "number": "1760021083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "535 WATSON DR",
            "city": "CLAREMONT",
            "state": "CA",
            "postal_code": "917114817",
            "telephone_number": "248-275-8317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26520 CACTUS AVE",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925553927",
            "telephone_number": "951-486-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOURTAKIS",
        "first_name": "STEPHANIE",
        "name_prefix": "Dr.",
        "credential": "PHARMD, BCACP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-03",
        "last_updated": "2020-01-03",
        "certification_date": "2020-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1835P2201X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Ambulatory Care",
            "state": "CA",
            "license": "RPH80480",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vandra Phen Kok, PHARMD
• Blanka Kong
• Iris Kong
• Ravinder Kooner
• Marilyn K Kostry, MSW, LCSW
• Chinwe Sonia Kpaduwa, MD
• Ann Pultz Kramer, M.F.T.
• Soloman Kreik, DO
• Adam Kreutzer, DO
• Padmaja Krishnan, DO

• Ambulatory Care Pharmacist in Moreno Valley, CA
• Providers in Moreno Valley, CA by specialty
• Ambulatory Care Pharmacist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.