Provider Demographics
NPI:1790938298
Name:PORNPUTTICHAI, KRITSANA (CPHT)
Entity Type:Individual
Prefix:MS
First Name:KRITSANA
Middle Name:
Last Name:PORNPUTTICHAI
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 HARDIE AVE SW APT 6
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-5947
Mailing Address - Country:US
Mailing Address - Phone:206-354-8591
Mailing Address - Fax:
Practice Address - Street 1:140 HARDIE AVE SW APT 6
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-5947
Practice Address - Country:US
Practice Address - Phone:206-354-8591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA60042259183700000X
DC450101080953305183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician