Provider Demographics
NPI:1588788327
Name:SAMBUCO, THUTRANG THI (PHARMD)
Entity type:Individual
Prefix:DR
First Name:THUTRANG
Middle Name:THI
Last Name:SAMBUCO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:FAITH
Other - Middle Name:THI
Other - Last Name:SAMBUCO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:318 AIGBURTH RD
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-7336
Mailing Address - Country:US
Mailing Address - Phone:410-769-9440
Mailing Address - Fax:410-583-0076
Practice Address - Street 1:120 SISTER PIERRE DR
Practice Address - Street 2:SUITE #207
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7516
Practice Address - Country:US
Practice Address - Phone:410-321-0889
Practice Address - Fax:410-321-1231
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13974183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD13974OtherPHARMACIST LICENSE