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NPI Code Detail

MEDICARE: KETFA INTHATHIRATH

MEDICARE: KETFA INTHATHIRATH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacistS026228AZ

General Provider Information

NPI Number : 1144930843
Entity Type Code : Individual
Provider Name (Legal Business Name) : KETFA INTHATHIRATH
Provider Business Mailing Address
First Line : 24250 N 23RD AVE UNIT 3188
Second Line :
City : PHOENIX
State : AZ
Zip : 85085-1990
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 28635 N NORTH VALLEY PKWY
Second Line :
City : PHOENIX
State : AZ
Zip : 85085-5434
Country : US
Telephone Number : 623-582-9207
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/02/2022
Last Update Date : 06/11/2026

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Directions to “ KETFA INTHATHIRATH ” Practice Location

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