MEDICARE: DR. KRITTAPORN NAN ROSENTHAL PHARM.D.

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
1	183500000X	Pharmacist	57381	CA

General Provider Information

NPI Number	:	1306120043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRITTAPORN NAN ROSENTHAL PHARM.D.

Provider Business Mailing Address
First Line	:	6416 TAMPA AVE
Second Line	:
City	:	RESEDA
State	:	CA
Zip	:	91335-6647
Country	:	US
Telephone Number	:	818-776-9014
Fax Number	:	818-776-5654

Provider Business Practice Location Address
First Line	:	6416 TAMPA AVE
Second Line	:
City	:	RESEDA
State	:	CA
Zip	:	91335-6647
Country	:	US
Telephone Number	:	818-776-9014
Fax Number	:	818-776-5654

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2011
Last Update Date	:	09/29/2011

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