Provider Demographics
NPI:1497020671
Name:HUI, DERIC TUAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DERIC
Middle Name:TUAN
Last Name:HUI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12034 SAN RIO ST
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91732-1234
Mailing Address - Country:US
Mailing Address - Phone:909-468-5588
Mailing Address - Fax:
Practice Address - Street 1:1336 BRIDGEGATE DR
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-3955
Practice Address - Country:US
Practice Address - Phone:909-468-5588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55108183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist