Provider Demographics
NPI:1265149355
Name:BAE, KEERATI (RPH)
Entity type:Individual
Prefix:DR
First Name:KEERATI
Middle Name:
Last Name:BAE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:DR
Other - First Name:KEERATI
Other - Middle Name:
Other - Last Name:ASAWALAPSAKUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7755 AMESTOY AVE
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-2112
Mailing Address - Country:US
Mailing Address - Phone:818-621-5560
Mailing Address - Fax:
Practice Address - Street 1:7755 AMESTOY AVE
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-2112
Practice Address - Country:US
Practice Address - Phone:818-621-5560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86886183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist