Provider Demographics
NPI:1386000123
Name:HUYNH, CU VAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CU
Middle Name:VAN
Last Name:HUYNH
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 1:1601 S LOWER SACRAMENTO RD
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95242-9762
Mailing Address - Country:US
Mailing Address - Phone:209-368-6658
Mailing Address - Fax:209-368-6660
Practice Address - Street 1:1601 S LOWER SACRAMENTO RD
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-9762
Practice Address - Country:US
Practice Address - Phone:209-368-6658
Practice Address - Fax:209-368-6660
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-09
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65415183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist