Individual
KETFA INTHATHIRATH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
28635 N NORTH VALLEY PKWY, PHOENIX, AZ 85085-5434
(623) 582-9207
Mailing address
24250 N 23RD AVE UNIT 3188, PHOENIX, AZ 85085-1990
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
S026228
AZ
Other
Enumeration date
12/02/2022
Last updated
12/02/2022
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