Provider Demographics
NPI:1174817837
Name:WAT, HUYNH (PHARM D)
Entity Type:Individual
Prefix:MS
First Name:HUYNH
Middle Name:
Last Name:WAT
Suffix:
Gender:F
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 1:2700 W 120TH ST
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-3388
Mailing Address - Country:US
Mailing Address - Phone:323-492-1001
Mailing Address - Fax:323-492-1011
Practice Address - Street 1:2700 W 120TH ST
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-3388
Practice Address - Country:US
Practice Address - Phone:323-492-1001
Practice Address - Fax:323-492-1011
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-30
Last Update Date:2011-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62497183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist