Provider Demographics
NPI:1447582275
Name:DIEP, THANH THAI (RPH)
Entity Type:Individual
Prefix:
First Name:THANH
Middle Name:THAI
Last Name:DIEP
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 1:3032 HOBART ST
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-1459
Mailing Address - Country:US
Mailing Address - Phone:718-721-1624
Mailing Address - Fax:
Practice Address - Street 1:931 1ST AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-8031
Practice Address - Country:US
Practice Address - Phone:212-421-1046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048547-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist