Provider Demographics
NPI:1528355252
Name:HUYNH, JONATHAN TUAN (PHAMD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:TUAN
Last Name:HUYNH
Suffix:
Gender:M
Credentials:PHAMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 W NORTH AVE
Mailing Address - Street 2:T-0837
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160-1611
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:850 W NORTH AVE
Practice Address - Street 2:T-0837
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-1611
Practice Address - Country:US
Practice Address - Phone:708-338-2795
Practice Address - Fax:708-338-2795
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-01
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.287379183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist