SURASAK JIM VASAVANONT

CHICAGO, IL
NPI1407133820
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy183500000X Pharmacist
(Licence: IL  051.293192)
Enumeration Date2011-11-14
Last Update Date2011-11-14
Business Address
Dr. SURASAK JIM VASAVANONT PharmD
6016 W 63RD ST
CHICAGO, IL 60638-4318
Phone number: 773-788-0180
Mailing Address
Dr. SURASAK JIM VASAVANONT PharmD
6016 W 63RD ST
CHICAGO, IL 60638-4318
Phone number: 773-788-0180
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