Provider Demographics
NPI:1053947226
Name:SANASITH, CHETTANA (PHARMD)
Entity type:Individual
Prefix:
First Name:CHETTANA
Middle Name:
Last Name:SANASITH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5707 VETERANS PKWY
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-9003
Mailing Address - Country:US
Mailing Address - Phone:706-322-6253
Mailing Address - Fax:706-322-8995
Practice Address - Street 1:1979 CARITHERS WAY
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-6012
Practice Address - Country:US
Practice Address - Phone:678-908-9189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-19
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH031592183500000X
GA333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No183500000XPharmacy Service ProvidersPharmacist