Provider Demographics
NPI:1225511934
Name:BUI, LONG PHI (PHARMD)
Entity Type:Individual
Prefix:
First Name:LONG PHI
Middle Name:
Last Name:BUI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:PHIL
Other - Middle Name:
Other - Last Name:BUI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:45 RENWORTH LN
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-6627
Mailing Address - Country:US
Mailing Address - Phone:386-264-1709
Mailing Address - Fax:
Practice Address - Street 1:414 BEACH VILLAGE DR
Practice Address - Street 2:
Practice Address - City:FLAGLER BEACH
Practice Address - State:FL
Practice Address - Zip Code:32136-3063
Practice Address - Country:US
Practice Address - Phone:386-517-2776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-09
Last Update Date:2018-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS49501183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist