Provider Demographics
NPI:1275044141
Name:SRIJUMNONG, SANTI (PHARMD)
Entity Type:Individual
Prefix:
First Name:SANTI
Middle Name:
Last Name:SRIJUMNONG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5929 CARPENTER AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-1309
Mailing Address - Country:US
Mailing Address - Phone:818-624-7409
Mailing Address - Fax:
Practice Address - Street 1:520 N LONE HILL AVE
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-1725
Practice Address - Country:US
Practice Address - Phone:909-962-5516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-19
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA76576183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist