Provider Demographics
NPI:1437845500
Name:THAMVONGKHAM, ANGELA
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:THAMVONGKHAM
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:PO BOX 32
Mailing Address - Street 2:
Mailing Address - City:HAMILTON CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95951-0032
Mailing Address - Country:US
Mailing Address - Phone:530-828-0059
Mailing Address - Fax:530-343-2378
Practice Address - Street 1:220 W EAST AVE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-7215
Practice Address - Country:US
Practice Address - Phone:530-343-9495
Practice Address - Fax:530-343-2378
Is Sole Proprietor?:No
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CATCH148645183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician