Provider Demographics
NPI:1427296995
Name:WONGWIWATTHANANUKIT, SUPAKIT (PHARMD, PHD)
Entity type:Individual
Prefix:DR
First Name:SUPAKIT
Middle Name:
Last Name:WONGWIWATTHANANUKIT
Suffix:
Gender:M
Credentials:PHARMD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50A MAILE ST APT 22
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-4349
Mailing Address - Country:US
Mailing Address - Phone:808-933-2947
Mailing Address - Fax:808-933-2974
Practice Address - Street 1:50 MAILE ST APT A22
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4381
Practice Address - Country:US
Practice Address - Phone:808-933-2947
Practice Address - Fax:808-933-2974
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPH-28051835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy