Provider Demographics
NPI:1710276878
Name:SIHATHEP, SOMCHAY SAM (PHARMD)
Entity Type:Individual
Prefix:
First Name:SOMCHAY
Middle Name:SAM
Last Name:SIHATHEP
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6074 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5405
Mailing Address - Country:US
Mailing Address - Phone:559-431-5231
Mailing Address - Fax:
Practice Address - Street 1:6074 N 1ST ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5405
Practice Address - Country:US
Practice Address - Phone:559-431-5231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55516183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist