Provider Demographics
NPI:1033820766
Name:THAI, ANNIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:
Last Name:THAI
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 1:736 E MANDEVILLA WAY
Mailing Address - Street 2:
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-1492
Mailing Address - Country:US
Mailing Address - Phone:626-632-5836
Mailing Address - Fax:
Practice Address - Street 1:14629 7TH ST
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-4019
Practice Address - Country:US
Practice Address - Phone:760-245-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0024183183500000X
CA87240183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist