Provider Demographics
NPI:1174861686
Name:BUI, MYLINH MAI (RPH)
Entity Type:Individual
Prefix:
First Name:MYLINH
Middle Name:MAI
Last Name:BUI
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 1:2943 SANTA MARCOS DR
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34715-8013
Mailing Address - Country:US
Mailing Address - Phone:678-231-0054
Mailing Address - Fax:
Practice Address - Street 1:250 CITRUS TOWER BLVD
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-2790
Practice Address - Country:US
Practice Address - Phone:352-241-6676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-18
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS43131183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist