Provider Demographics
NPI:1356011852
Name:VU, NAM THANH (PHARMD)
Entity Type:Individual
Prefix:
First Name:NAM
Middle Name:THANH
Last Name:VU
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11245 US HIGHWAY 301 N
Mailing Address - Street 2:
Mailing Address - City:PARRISH
Mailing Address - State:FL
Mailing Address - Zip Code:34219-8675
Mailing Address - Country:US
Mailing Address - Phone:941-776-0890
Mailing Address - Fax:941-776-8042
Practice Address - Street 1:11245 US HIGHWAY 301 N
Practice Address - Street 2:
Practice Address - City:PARRISH
Practice Address - State:FL
Practice Address - Zip Code:34219-8675
Practice Address - Country:US
Practice Address - Phone:941-776-0890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-16
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS63221183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist