Provider Demographics
NPI:1003195629
Name:DOAN, THAO KIM (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:THAO
Middle Name:KIM
Last Name:DOAN
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 1:230 GRAND ST STE A1-2
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4241
Mailing Address - Country:US
Mailing Address - Phone:212-219-8998
Mailing Address - Fax:
Practice Address - Street 1:230 GRAND ST
Practice Address - Street 2:SUITE A1-2
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4241
Practice Address - Country:US
Practice Address - Phone:212-219-8998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-13
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055951183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist