Provider Demographics
NPI:1073725578
Name:LUANGKESORN, PANITA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:PANITA
Middle Name:
Last Name:LUANGKESORN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E RANDOLPH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-5014
Mailing Address - Country:US
Mailing Address - Phone:312-653-4932
Mailing Address - Fax:312-946-8121
Practice Address - Street 1:300 E RANDOLPH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-5014
Practice Address - Country:US
Practice Address - Phone:312-653-4932
Practice Address - Fax:312-946-8121
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051290802183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist