Provider Demographics
NPI:1700297173
Name:PITAK, SOM (PHARM D)
Entity Type:Individual
Prefix:MR
First Name:SOM
Middle Name:
Last Name:PITAK
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:MR
Other - First Name:SOMKIAT
Other - Middle Name:
Other - Last Name:PITAK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARM D
Mailing Address - Street 1:5100 LAGUNA BLVD.
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758
Mailing Address - Country:US
Mailing Address - Phone:916-684-7007
Mailing Address - Fax:916-684-6489
Practice Address - Street 1:5100 LAGUNA BLVD.
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758
Practice Address - Country:US
Practice Address - Phone:916-684-7007
Practice Address - Fax:916-684-6489
Is Sole Proprietor?:No
Enumeration Date:2014-05-19
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47266183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist