MEDICARE: MISS SURAPEE CHETNAKARNKUL RPH

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	RPH 37648	CA

General Provider Information

NPI Number	:	1760805683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS SURAPEE CHETNAKARNKUL RPH

Provider Business Mailing Address
First Line	:	7360 KENSINGTON DR
Second Line	:
City	:	BUENA PARK
State	:	CA
Zip	:	90621-3949
Country	:	US
Telephone Number	:	714-562-0474
Fax Number	:

Provider Business Practice Location Address
First Line	:	1770 W CARSON ST
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90501-2821
Country	:	US
Telephone Number	:	310-787-8861
Fax Number	:	310-787-8831

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

Provider Enumeration Date	:	01/29/2014
Last Update Date	:	01/29/2014

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