Provider Demographics
NPI:1396033155
Name:CHAROENSATIT, KATY SUE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KATY
Middle Name:SUE
Last Name:CHAROENSATIT
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 1:1085 N OREGON ST
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914-1549
Mailing Address - Country:US
Mailing Address - Phone:541-889-6157
Mailing Address - Fax:541-889-6148
Practice Address - Street 1:1085 N OREGON ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-1549
Practice Address - Country:US
Practice Address - Phone:541-889-6157
Practice Address - Fax:541-889-6148
Is Sole Proprietor?:No
Enumeration Date:2011-07-14
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0012653183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist