Provider Demographics
NPI:1114462223
Name:NERNSUAN, JUSTIN BOONCHAI (PHD)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:BOONCHAI
Last Name:NERNSUAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 TWIN CREEKS CIR
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93905-4819
Mailing Address - Country:US
Mailing Address - Phone:818-515-9238
Mailing Address - Fax:
Practice Address - Street 1:2 TWIN CREEKS CIR
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93905-4819
Practice Address - Country:US
Practice Address - Phone:818-515-9238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-28
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH75817183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist