Provider Demographics
NPI:1528561552
Name:THAN, SCOTT THA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:THA
Last Name:THAN
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 1:2851 HEATHER RD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-1050
Mailing Address - Country:US
Mailing Address - Phone:562-822-9537
Mailing Address - Fax:
Practice Address - Street 1:921 PACIFIC COAST HWY
Practice Address - Street 2:
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-6244
Practice Address - Country:US
Practice Address - Phone:562-598-0473
Practice Address - Fax:562-598-6773
Is Sole Proprietor?:No
Enumeration Date:2018-03-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55624183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist