Provider Demographics
NPI:1265046049
Name:AKRAMUNKONGVANICH, PATCHARAVI (PHARMD)
Entity Type:Individual
Prefix:
First Name:PATCHARAVI
Middle Name:
Last Name:AKRAMUNKONGVANICH
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 1:2020 S NAPERVILLE RD # RS
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-8171
Mailing Address - Country:US
Mailing Address - Phone:630-682-2582
Mailing Address - Fax:
Practice Address - Street 1:2020 S NAPERVILLE RD # RS
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189-8171
Practice Address - Country:US
Practice Address - Phone:630-682-2582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.300933183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist