Provider Demographics
NPI:1164820502
Name:THI, PHILIP
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:THI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:PHILIP
Other - Middle Name:
Other - Last Name:THI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARM D
Mailing Address - Street 1:117 E LIVE OAK AVE
Mailing Address - Street 2:SUITE #201
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-5269
Mailing Address - Country:US
Mailing Address - Phone:626-247-2222
Mailing Address - Fax:
Practice Address - Street 1:117 E LIVE OAK AVE
Practice Address - Street 2:SUITE #201
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-5269
Practice Address - Country:US
Practice Address - Phone:626-247-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-17
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA67887183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist