Provider Demographics
NPI:1508299249
Name:WANG, THANH HIEN THI (PHARMD)
Entity Type:Individual
Prefix:
First Name:THANH HIEN
Middle Name:THI
Last Name:WANG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 NW 22ND AVE STE 420
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3062
Mailing Address - Country:US
Mailing Address - Phone:503-406-3809
Mailing Address - Fax:
Practice Address - Street 1:1040 NW 22ND AVE STE 420
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3062
Practice Address - Country:US
Practice Address - Phone:503-406-3809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-16
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD14044183500000X
HIPH-3984183500000X
KS1-105105183500000X
MAPH236427183500000X
MI5302044409183500000X
TX58312183500000X
GUPH0323183500000X
OKR-16582183500000X
AL19109183500000X
NE15203183500000X
IL051299275183500000X
DEA1-0004894183500000X
IDP7416183500000X
OR0013698183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist