Healthcare Provider Details

I. General information

NPI: 1609795707
Provider Name (Legal Business Name): SIRIPANN LAOHATONGTIP RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 BLOSSOM HILL RD
LOS GATOS CA
95032-3503
US

IV. Provider business mailing address

750 BLOSSOM HILL RD
LOS GATOS CA
95032-3503
US

V. Phone/Fax

Practice location:
  • Phone: 408-356-3464
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number92522
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: