Provider Demographics
NPI:1467330266
Name:HO, PHU NGUYEN-THIEN
Entity type:Individual
Prefix:
First Name:PHU
Middle Name:NGUYEN-THIEN
Last Name:HO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3919 RICHMOND ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-2419
Mailing Address - Country:US
Mailing Address - Phone:517-582-2553
Mailing Address - Fax:
Practice Address - Street 1:152 W SPRAGUE RD
Practice Address - Street 2:
Practice Address - City:IONIA
Practice Address - State:MI
Practice Address - Zip Code:48846-7402
Practice Address - Country:US
Practice Address - Phone:616-527-1392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-21
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302417859183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist