Provider Demographics
NPI:1003068305
Name:SAGUANDEEKUL, SUTTINEE (RPH)
Entity Type:Individual
Prefix:
First Name:SUTTINEE
Middle Name:
Last Name:SAGUANDEEKUL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 QUEVA VIS
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-2109
Mailing Address - Country:US
Mailing Address - Phone:415-899-0154
Mailing Address - Fax:415-899-0154
Practice Address - Street 1:910 DIABLO AVE
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94947
Practice Address - Country:US
Practice Address - Phone:415-898-1905
Practice Address - Fax:415-898-5121
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 38519183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARPH38519OtherSTATE LICENSE