Provider Demographics
NPI:1255494589
Name:TU QUYNH PHARMACY, INC.
Entity Type:Organization
Organization Name:TU QUYNH PHARMACY, INC.
Other - Org Name:TU QUYNH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THAO
Authorized Official - Middle Name:KIM
Authorized Official - Last Name:DOAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:212-219-8998
Mailing Address - Street 1:230 GRAND ST # A1-2
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4241
Mailing Address - Country:US
Mailing Address - Phone:212-219-8998
Mailing Address - Fax:212-219-3822
Practice Address - Street 1:230 GRAND ST # A1-2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4241
Practice Address - Country:US
Practice Address - Phone:212-219-8998
Practice Address - Fax:212-219-3822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049472183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02657990Medicaid
NY5426880001Medicare NSC