Healthcare Provider Details

I. General information

NPI: 1003068305
Provider Name (Legal Business Name): SUTTINEE SAGUANDEEKUL RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2008
Last Update Date: 10/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 DIABLO AVE
NOVATO CA
94947
US

IV. Provider business mailing address

82 QUEVA VIS
NOVATO CA
94947-2109
US

V. Phone/Fax

Practice location:
  • Phone: 415-898-1905
  • Fax: 415-898-5121
Mailing address:
  • Phone: 415-899-0154
  • Fax: 415-899-0154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH 38519
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: