Provider Demographics
NPI:1457449514
Name:CHU, THANG TAT (PHARMACIST)
Entity Type:Individual
Prefix:DR
First Name:THANG
Middle Name:TAT
Last Name:CHU
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12422 LEE LN
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-3464
Mailing Address - Country:US
Mailing Address - Phone:714-662-0548
Mailing Address - Fax:714-662-0549
Practice Address - Street 1:12422 LEE LN
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-3464
Practice Address - Country:US
Practice Address - Phone:714-662-0548
Practice Address - Fax:714-662-0549
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55506183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA55506OtherRPH LICENSE