Provider Demographics
NPI:1467002766
Name:TIEN, TAN NHUT (PHARMACIST)
Entity Type:Individual
Prefix:DR
First Name:TAN
Middle Name:NHUT
Last Name:TIEN
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 1:119 W MESQUITE ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-6412
Mailing Address - Country:US
Mailing Address - Phone:480-678-9962
Mailing Address - Fax:
Practice Address - Street 1:240 W BASELINE RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-6107
Practice Address - Country:US
Practice Address - Phone:480-678-9962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS024257183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist