Provider Demographics
NPI:1679797328
Name:CHAIRIN, TANAPONG (RPH)
Entity Type:Individual
Prefix:
First Name:TANAPONG
Middle Name:
Last Name:CHAIRIN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 N 16TH PL
Mailing Address - Street 2:
Mailing Address - City:STURGEON BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54235-1348
Mailing Address - Country:US
Mailing Address - Phone:920-743-3649
Mailing Address - Fax:
Practice Address - Street 1:1300 EGG HARBOR RD STE 112
Practice Address - Street 2:
Practice Address - City:STURGEON BAY
Practice Address - State:WI
Practice Address - Zip Code:54235-1248
Practice Address - Country:US
Practice Address - Phone:920-746-2977
Practice Address - Fax:920-746-2962
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14090-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist