Provider Demographics
NPI:1669075859
Name:VATTHANATHAM, SITT SAK (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SITT
Middle Name:SAK
Last Name:VATTHANATHAM
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 1:1509 LEXINGTON CIR
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:AR
Mailing Address - Zip Code:72956-7801
Mailing Address - Country:US
Mailing Address - Phone:479-831-7605
Mailing Address - Fax:
Practice Address - Street 1:2100 N 62ND ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72904-5163
Practice Address - Country:US
Practice Address - Phone:479-782-0606
Practice Address - Fax:479-783-2206
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD08335183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist