Provider Demographics
NPI:1588955421
Name:ONGSUWAN, CHEWAROM
Entity type:Individual
Prefix:
First Name:CHEWAROM
Middle Name:
Last Name:ONGSUWAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19803 SW JETTE LN
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-2790
Mailing Address - Country:US
Mailing Address - Phone:503-803-7966
Mailing Address - Fax:
Practice Address - Street 1:2425 SE TUALATIN VALLEY HWY
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-7977
Practice Address - Country:US
Practice Address - Phone:503-693-1009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0010568183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist