Provider Demographics
NPI:1275170649
Name:DIEP, THI THI HOANG (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:THI THI
Middle Name:HOANG
Last Name:DIEP
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 MARQUIS LN
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-9123
Mailing Address - Country:US
Mailing Address - Phone:817-405-9291
Mailing Address - Fax:
Practice Address - Street 1:503 MARQUIS LN
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-9123
Practice Address - Country:US
Practice Address - Phone:817-405-9291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-04
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX60358183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty