Provider Demographics
NPI:1255507331
Name:THAI, LUCY B
Entity Type:Individual
Prefix:
First Name:LUCY
Middle Name:B
Last Name:THAI
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 1:20552 MONTAUK CIR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-5934
Mailing Address - Country:US
Mailing Address - Phone:714-321-1905
Mailing Address - Fax:
Practice Address - Street 1:15800 IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-2512
Practice Address - Country:US
Practice Address - Phone:562-902-5538
Practice Address - Fax:562-902-6517
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2015-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51854183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist