Provider Demographics
NPI:1396045662
Name:HUYNH, TINA PHUONG (RPH)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:PHUONG
Last Name:HUYNH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14826 HWY 99 N
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98087
Mailing Address - Country:US
Mailing Address - Phone:425-743-6808
Mailing Address - Fax:425-742-8595
Practice Address - Street 1:14826 HWY 99
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98087-2322
Practice Address - Country:US
Practice Address - Phone:425-743-6808
Practice Address - Fax:425-742-8595
Is Sole Proprietor?:No
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00016391183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist