MEDICARE: DR. THUTHAPORN WONGSE-SANIT 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	16891	NV

General Provider Information

NPI Number	:	1831472182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THUTHAPORN WONGSE-SANIT PHARM D

Provider Business Mailing Address
First Line	:	7640 MORNING WATER ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-1663
Country	:	US
Telephone Number	:	702-501-0662
Fax Number	:

Provider Business Practice Location Address
First Line	:	451 S DECATUR BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-2805
Country	:	US
Telephone Number	:	702-870-1626
Fax Number	:

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

Provider Enumeration Date	:	09/23/2011
Last Update Date	:	09/23/2011

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