Provider Demographics
NPI:1528406618
Name:STAMM, SIRANYA WICHATORN (RPH)
Entity Type:Individual
Prefix:
First Name:SIRANYA
Middle Name:WICHATORN
Last Name:STAMM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1661 W FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-3818
Mailing Address - Country:US
Mailing Address - Phone:951-929-5351
Mailing Address - Fax:951-929-2521
Practice Address - Street 1:1661 W FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-3818
Practice Address - Country:US
Practice Address - Phone:951-929-5351
Practice Address - Fax:951-929-2521
Is Sole Proprietor?:No
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA68381183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist