Provider Demographics
NPI:1306624960
Name:INTHONG, VORALAK (RPH)
Entity type:Individual
Prefix:
First Name:VORALAK
Middle Name:
Last Name:INTHONG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6440 STONERIDGE MALL RD APT K220
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-8079
Mailing Address - Country:US
Mailing Address - Phone:303-304-3795
Mailing Address - Fax:
Practice Address - Street 1:6440 STONERIDGE MALL RD APT K220
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-8079
Practice Address - Country:US
Practice Address - Phone:303-304-3795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88478183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist