Provider Demographics
NPI:1447660717
Name:SUWANSANYA, JIRAPA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JIRAPA
Middle Name:
Last Name:SUWANSANYA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16675 SLATE DR
Mailing Address - Street 2:UNIT 126
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-7401
Mailing Address - Country:US
Mailing Address - Phone:312-404-0522
Mailing Address - Fax:
Practice Address - Street 1:16675 SLATE DR
Practice Address - Street 2:UNIT 126
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-7401
Practice Address - Country:US
Practice Address - Phone:312-404-0522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-07
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA70596183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist