Provider Demographics
NPI:1457240004
Name:HUYNH, BAO AN
Entity type:Individual
Prefix:
First Name:BAO AN
Middle Name:
Last Name:HUYNH
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5220 BRIGITTE CT
Mailing Address - Street 2:
Mailing Address - City:GROVES
Mailing Address - State:TX
Mailing Address - Zip Code:77619-3200
Mailing Address - Country:US
Mailing Address - Phone:225-270-4961
Mailing Address - Fax:
Practice Address - Street 1:3605 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4617
Practice Address - Country:US
Practice Address - Phone:409-832-7374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63091183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist