Provider Demographics
NPI:1962029173
Name:SAKDIPANICHKUL, SUTHIDA SAMANTHA
Entity Type:Individual
Prefix:
First Name:SUTHIDA
Middle Name:SAMANTHA
Last Name:SAKDIPANICHKUL
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 1:8931 SW 19TH ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-7614
Mailing Address - Country:US
Mailing Address - Phone:954-654-0154
Mailing Address - Fax:
Practice Address - Street 1:8931 SW 19TH ST
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-7614
Practice Address - Country:US
Practice Address - Phone:954-654-0154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-03
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL38032183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist