Provider Demographics
NPI:1386296150
Name:PANTASRI, TANAPONG (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TANAPONG
Middle Name:
Last Name:PANTASRI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:TANAPONG
Other - Middle Name:
Other - Last Name:PANTASRI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD, RPH, BCMTMS
Mailing Address - Street 1:7316 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-6336
Mailing Address - Country:US
Mailing Address - Phone:917-832-6035
Mailing Address - Fax:917-832-6426
Practice Address - Street 1:7316 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-6336
Practice Address - Country:US
Practice Address - Phone:917-832-6035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-11
Last Update Date:2020-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY066612183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist