Provider Demographics
NPI:1073773776
Name:CN THAI CORPORATION
Entity Type:Organization
Organization Name:CN THAI CORPORATION
Other - Org Name:CRENSHAW PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CANH
Authorized Official - Middle Name:DUC
Authorized Official - Last Name:THAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-660-8752
Mailing Address - Street 1:5010 CRENSHAW RD STE 160
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77505-3047
Mailing Address - Country:US
Mailing Address - Phone:281-998-2777
Mailing Address - Fax:281-998-2779
Practice Address - Street 1:5010 CRENSHAW RD STE 160
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-3047
Practice Address - Country:US
Practice Address - Phone:281-998-2777
Practice Address - Fax:281-998-2779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-16
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX146016Medicaid
TX146016Medicaid