Provider Demographics
NPI:1578000394
Name:POUPONGTONG, POONSIN (REGISTERED PHARMACIS)
Entity Type:Individual
Prefix:MR
First Name:POONSIN
Middle Name:
Last Name:POUPONGTONG
Suffix:
Gender:M
Credentials:REGISTERED PHARMACIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9449 IMPERIAL HWY BLDG A
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242-2814
Mailing Address - Country:US
Mailing Address - Phone:562-657-2604
Mailing Address - Fax:562-657-2395
Practice Address - Street 1:9449 IMPERIAL HWY BLDG A
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-2814
Practice Address - Country:US
Practice Address - Phone:562-657-2604
Practice Address - Fax:562-657-2395
Is Sole Proprietor?:No
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist