Provider Demographics
NPI:1285069740
Name:VO, THU THI PHUONG (PHARMD)
Entity type:Individual
Prefix:
First Name:THU
Middle Name:THI PHUONG
Last Name:VO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:VO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:9712 INGRAM AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-2945
Mailing Address - Country:US
Mailing Address - Phone:408-892-7695
Mailing Address - Fax:
Practice Address - Street 1:1775 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-5732
Practice Address - Country:US
Practice Address - Phone:928-763-8777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSO19999183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist