Provider Demographics
NPI:1083932677
Name:DO, THACH PHAN (RPH)
Entity Type:Individual
Prefix:MR
First Name:THACH
Middle Name:PHAN
Last Name:DO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:TODD
Other - Middle Name:
Other - Last Name:DO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:5881 WARNER AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-4657
Mailing Address - Country:US
Mailing Address - Phone:714-846-5291
Mailing Address - Fax:714-846-8936
Practice Address - Street 1:17119 BUTTONWOOD ST
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-3506
Practice Address - Country:US
Practice Address - Phone:714-846-5291
Practice Address - Fax:714-846-8936
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-07
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44837183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist