Provider Demographics
NPI:1487243242
Name:DINH, PHUONG THAO THI (PHARMD)
Entity type:Individual
Prefix:DR
First Name:PHUONG
Middle Name:THAO THI
Last Name:DINH
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 1:2794 SUN RISE LN
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-8581
Mailing Address - Country:US
Mailing Address - Phone:682-553-3886
Mailing Address - Fax:
Practice Address - Street 1:6756 W VICKERY BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-9156
Practice Address - Country:US
Practice Address - Phone:817-732-2130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-14
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68094183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist