Provider Demographics
NPI:1508468380
Name:HUYNH, THAO (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:THAO
Middle Name:
Last Name:HUYNH
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 1:115 SPANISH CV
Mailing Address - Street 2:
Mailing Address - City:WAVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39576-2535
Mailing Address - Country:US
Mailing Address - Phone:228-223-3851
Mailing Address - Fax:
Practice Address - Street 1:115 SPANISH CV
Practice Address - Street 2:
Practice Address - City:WAVELAND
Practice Address - State:MS
Practice Address - Zip Code:39576-2535
Practice Address - Country:US
Practice Address - Phone:228-223-3851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0234511835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist