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NPI Code Detail

MEDICARE: PRATANA CHAROENPHOL

MEDICARE: PRATANA CHAROENPHOL
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
1183500000XPharmacistS016570AZ

General Provider Information

NPI Number : 1891022380
Entity Type Code : Individual
Provider Name (Legal Business Name) : PRATANA CHAROENPHOL
Provider Business Mailing Address
First Line : 80 ACOMA BLVD N
Second Line :
City : LAKE HAVASU CITY
State : AZ
Zip : 86403-6932
Country : US
Telephone Number : 928-680-4449
Fax Number : 928-680-6122
Provider Business Practice Location Address
First Line : 80 ACOMA BLVD N
Second Line :
City : LAKE HAVASU CITY
State : AZ
Zip : 86403-6932
Country : US
Telephone Number : 928-680-4449
Fax Number : 928-680-6122
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/04/2009
Last Update Date : 11/04/2009

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Directions to “ PRATANA CHAROENPHOL ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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