Provider Demographics
NPI:1205204666
Name:TACHASOOKSAREE, KANIT
Entity Type:Individual
Prefix:
First Name:KANIT
Middle Name:
Last Name:TACHASOOKSAREE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2623 POINTE COUPEE
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-5156
Mailing Address - Country:US
Mailing Address - Phone:909-837-9179
Mailing Address - Fax:
Practice Address - Street 1:2623 POINTE COUPEE
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-5156
Practice Address - Country:US
Practice Address - Phone:909-837-9179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-02
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73132183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist