Provider Demographics
NPI:1710566740
Name:ROJPRASITPORN, NUTTAVAT (RPH)
Entity Type:Individual
Prefix:MR
First Name:NUTTAVAT
Middle Name:
Last Name:ROJPRASITPORN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:NUTTAVAT
Other - Middle Name:
Other - Last Name:ROJPRASITPORN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:2890 NORTHTOWNE LN
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89512-2178
Mailing Address - Country:US
Mailing Address - Phone:775-358-4238
Mailing Address - Fax:
Practice Address - Street 1:2890 NORTHTOWNE LN
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89512-2178
Practice Address - Country:US
Practice Address - Phone:775-328-4238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV19161183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1308313OtherCVS