Healthcare Provider Details

I. General information

NPI: 1932480126
Provider Name (Legal Business Name): NATETRIYA RERNGSAMAI-NHE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2011
Last Update Date: 09/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1329 UNIVERSITY BLVD E
TAKOMA PARK MD
20912-7445
US

IV. Provider business mailing address

1329 UNIVERSITY BLVD E
TAKOMA PARK MD
20912-7445
US

V. Phone/Fax

Practice location:
  • Phone: 301-445-8159
  • Fax: 301-439-0393
Mailing address:
  • Phone: 301-445-8159
  • Fax: 301-439-0393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number19719
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: