MEDICARE: SANTI HOMPUANGPHOO

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	S013080	AZ
2	183500000X	Pharmacist	PH3612	HI
3	183500000X	Pharmacist	051286813	IL

General Provider Information

NPI Number	:	1598361594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANTI HOMPUANGPHOO

Provider Business Mailing Address
First Line	:	3343 W MONTROSE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-1205
Country	:	US
Telephone Number	:	773-279-2929
Fax Number	:	773-279-2935

Provider Business Practice Location Address
First Line	:	3343 W MONTROSE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-1205
Country	:	US
Telephone Number	:	773-279-2929
Fax Number	:	773-279-2935

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

Provider Enumeration Date	:	12/07/2020
Last Update Date	:	12/07/2020

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Directions to “ SANTI HOMPUANGPHOO ” Practice Location

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