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General NPI Number Information
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NPI Number | 1619496221
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Entity Type | Individual
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Provider Name | WARAWAN PUNTUWONGSA PHARMD
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Gender | Female
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Dates
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Enumeration Date | 09/14/2017
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Last Update Date | 09/14/2017
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Provider Practice Location Address
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Address Line | 1925 E ANDY DEVINE AVE
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City | KINGMAN
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State | AZ
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Zip | 86401-7101
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Country | US
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Telephone | 928-753-7766
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Fax | 928-753-7786
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Provider Business Mailing Address
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Address Line | 6283 SANTANDER AVE
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City | LAS VEGAS
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State | NV
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Zip | 89103-2299
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Country | US
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Telephone | 702-324-4871
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Fax |
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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 | S021143
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License Number State | AZ
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