Provider Demographics
NPI:1699056796
Name:HUYNH, THAO (PHARMD)
Entity type:Individual
Prefix:MS
First Name:THAO
Middle Name:
Last Name:HUYNH
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 1:6344 W SOPHIE LN
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-2779
Mailing Address - Country:US
Mailing Address - Phone:602-334-3391
Mailing Address - Fax:
Practice Address - Street 1:1116 E FLORENCE BLVD
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-4216
Practice Address - Country:US
Practice Address - Phone:520-421-9920
Practice Address - Fax:520-421-2874
Is Sole Proprietor?:No
Enumeration Date:2011-09-01
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS018839183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist