Provider Demographics
NPI:1083045876
Name:HUYNH, THAO PHUONG (RPH)
Entity Type:Individual
Prefix:
First Name:THAO
Middle Name:PHUONG
Last Name:HUYNH
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 1:8221 WILLOW OAKS CORPORATE DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-8555
Mailing Address - Country:US
Mailing Address - Phone:703-852-0041
Mailing Address - Fax:703-289-2790
Practice Address - Street 1:8221 WILLOW OAKS CORPORATE DR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4512
Practice Address - Country:US
Practice Address - Phone:703-852-0041
Practice Address - Fax:703-289-2790
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-05
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH226461835P1300X
VA02022055061835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatric