Provider Demographics
NPI:1366921736
Name:THAI, JOANNE THANH (PHARMD)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:THANH
Last Name:THAI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 TULLY RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122-3054
Mailing Address - Country:US
Mailing Address - Phone:408-882-3558
Mailing Address - Fax:
Practice Address - Street 1:1310 TULLY RD STE 101
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-3054
Practice Address - Country:US
Practice Address - Phone:408-882-3558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-07
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67931183500000X
CA75194183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist