Provider Demographics
NPI:1285237495
Name:LERTWORASIRI, PIYAMAS (PHARMD)
Entity type:Individual
Prefix:
First Name:PIYAMAS
Middle Name:
Last Name:LERTWORASIRI
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 1:1184 DAKOTA DR
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-8253
Mailing Address - Country:US
Mailing Address - Phone:561-267-8368
Mailing Address - Fax:
Practice Address - Street 1:5561 SE FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-6641
Practice Address - Country:US
Practice Address - Phone:772-283-6940
Practice Address - Fax:
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
FLPS55671183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist