Active NPI
Glenn Chanitthikul, PHARMD
- Pharmacist
- Mishawaka, IN
National Provider Identifier
1265026728
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 26029067A
- Practice address
- 420 W 4TH St
Mishawaka, IN 46544-1948 - Phone
- (574) 307-7685
- Fax
- (574) 307-7683
- NPI assigned
- Feb 25, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 051302873 | IL | |
| Pharmacist | 183500000X | 03440404 | OH | |
| Pharmacist | 183500000X | 2020033888 | MO | |
| Pharmacist | 183500000X | 26029067A | IN | Primary |
Addresses
Primary practice location
420 W 4TH St
Mishawaka, IN 46544-1948
Mailing address
420 W 4TH St
Mishawaka, IN 46544-1948
Phone (574) 307-7685
Other practice location 1
1001 Sturdy Rd
Valparaiso, IN 46383-4126
Phone (219) 465-9505
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051302873 | IL | MD | Pharmacist |
| 26029067A | IN | MD | Pharmacist |
| 2020033888 | MO | MD | Pharmacist |
| 03440404 | OH | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1614211200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1614211200000",
"number": "1265026728",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "420 W 4TH ST",
"city": "MISHAWAKA",
"state": "IN",
"postal_code": "465441948",
"telephone_number": "574-307-7685",
"fax_number": "574-307-7683"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "420 W 4TH ST",
"city": "MISHAWAKA",
"state": "IN",
"postal_code": "465441948",
"telephone_number": "574-307-7685",
"fax_number": "574-307-7683"
}
],
"practiceLocations": [
{
"address_1": "1001 Sturdy Rd",
"address_purpose": "LOCATION",
"city": "Valparaiso",
"state": "IN",
"postal_code": "463834126",
"country_code": "US",
"telephone_number": "219-465-9505",
"fax_number": "219-465-9519",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CHANITTHIKUL",
"first_name": "GLENN",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-02-25",
"last_updated": "2021-02-25",
"certification_date": "2021-02-25",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": "051302873",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OH",
"license": "03440404",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MO",
"license": "2020033888",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IN",
"license": "26029067A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mishawaka, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.