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General NPI Number Information
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NPI Number | 1386296150
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Entity Type | Individual
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Provider Name | TANAPONG PANTASRI PHARM.D
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Gender | Male
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Dates
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Enumeration Date | 07/11/2019
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Last Update Date | 05/30/2020
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Provider Practice Location Address
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Address Line | 7316 ROOSEVELT AVE
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City | JACKSON HEIGHTS
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State | NY
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Zip | 11372-6336
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Country | US
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Telephone | 917-832-6035
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Fax |
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Provider Business Mailing Address
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Address Line | 7316 ROOSEVELT AVE
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City | JACKSON HEIGHTS
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State | NY
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Zip | 11372-6336
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Country | US
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Telephone | 917-832-6035
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Fax | 917-832-6426
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 066612
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 066612
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License Number State | NY
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