Provider Demographics
NPI:1194043612
Name:VINH, THAO LEANNE
Entity Type:Individual
Prefix:
First Name:THAO
Middle Name:LEANNE
Last Name:VINH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 BRENTMEADE DR
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23693-2574
Mailing Address - Country:US
Mailing Address - Phone:757-358-2293
Mailing Address - Fax:757-872-9247
Practice Address - Street 1:13349 WARWICK BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602
Practice Address - Country:US
Practice Address - Phone:757-877-0253
Practice Address - Fax:757-872-9247
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-07
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202009148183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist