Active NPI
Sandra Souvannachak, PHARMD
- Pharmacist
- Broken Arrow, OK
National Provider Identifier
1952902447
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 15504
- Practice address
- 2301 W Kenosha St
Broken Arrow, OK 74012-8912 - Phone
- (918) 259-9136
- Fax
- (918) 259-9141
- NPI assigned
- Nov 3, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 15504 | OK | Primary |
Addresses
Primary practice location
2301 W Kenosha St
Broken Arrow, OK 74012-8912
Mailing address
2301 W Kenosha St
Broken Arrow, OK 74012-8912
Phone (918) 259-9136
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15504 | OK | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1604361600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1604361600000",
"number": "1952902447",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2301 W KENOSHA ST",
"city": "BROKEN ARROW",
"state": "OK",
"postal_code": "740128912",
"telephone_number": "918-259-9136",
"fax_number": "918-259-9141"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2301 W KENOSHA ST",
"city": "BROKEN ARROW",
"state": "OK",
"postal_code": "740128912",
"telephone_number": "918-259-9136",
"fax_number": "918-259-9141"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SOUVANNACHAK",
"first_name": "SANDRA",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-11-03",
"last_updated": "2020-11-03",
"certification_date": "2020-11-03",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OK",
"license": "15504",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Broken Arrow, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 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.