Provider Demographics
NPI:1003148602
Name:THAI-HO, HOANG BUU (RPH)
Entity Type:Individual
Prefix:MRS
First Name:HOANG
Middle Name:BUU
Last Name:THAI-HO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 AVENUE J
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-3708
Mailing Address - Country:US
Mailing Address - Phone:718-253-8080
Mailing Address - Fax:718-253-7580
Practice Address - Street 1:1520 AVENUE J
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-3708
Practice Address - Country:US
Practice Address - Phone:718-253-8080
Practice Address - Fax:718-253-7580
Is Sole Proprietor?:No
Enumeration Date:2010-02-05
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045340183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01803603Medicaid