Provider Demographics
NPI:1073114377
Name:LUONG, TIN THANH (PHARM D)
Entity Type:Individual
Prefix:
First Name:TIN
Middle Name:THANH
Last Name:LUONG
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13115 SLEEPY CREEK MDWS
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-1709
Mailing Address - Country:US
Mailing Address - Phone:832-997-1840
Mailing Address - Fax:
Practice Address - Street 1:12503 EXCHANGE DR STE 536
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-3607
Practice Address - Country:US
Practice Address - Phone:713-391-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX43989183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist