Individual
GLENN CHANITTHIKUL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
420 W 4TH ST, MISHAWAKA, IN 46544-1948
(574) 307-7685
(574) 307-7683
Mailing address
420 W 4TH ST, MISHAWAKA, IN 46544-1948
(574) 307-7685
(574) 307-7683
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
03440404
OH
183500000X
Pharmacist
051302873
IL
183500000X
Pharmacist
2020033888
MO
183500000X
Pharmacist
Primary
26029067A
IN
Other
Enumeration date
02/25/2021
Last updated
02/25/2021
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