Provider Demographics
NPI:1588031884
Name:SITTISUNTORN, TUANGPORN
Entity Type:Individual
Prefix:
First Name:TUANGPORN
Middle Name:
Last Name:SITTISUNTORN
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 1:1085 COTTINGHAM BLVD N
Mailing Address - Street 2:
Mailing Address - City:BENNETTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29512-2868
Mailing Address - Country:US
Mailing Address - Phone:843-479-8355
Mailing Address - Fax:
Practice Address - Street 1:1085 COTTINGHAM BLVD N
Practice Address - Street 2:
Practice Address - City:BENNETTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29512-2868
Practice Address - Country:US
Practice Address - Phone:843-479-8355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-21
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC36225183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist