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General NPI Number Information
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NPI Number | 1841968385
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Entity Type | Individual
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Provider Name | ANDREW AKAPOB KAEWTAVORN
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Gender | Male
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Dates
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Enumeration Date | 08/31/2021
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Last Update Date | 08/31/2021
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Provider Practice Location Address
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Address Line | 725 CENTER DR
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City | SAN MARCOS
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State | CA
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Zip | 92069-3536
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Country | US
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Telephone | 760-871-6867
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Fax |
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Provider Business Mailing Address
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Address Line | 1427 N IVY ST
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City | ESCONDIDO
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State | CA
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Zip | 92026-2722
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Country | US
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Telephone | 909-247-5534
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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 | 82842
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License Number State | CA
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