Provider Demographics
NPI:1538670740
Name:HTUT, MAUNG YE (PHARMD)
Entity Type:Individual
Prefix:
First Name:MAUNG
Middle Name:YE
Last Name:HTUT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:MAUNG
Other - Middle Name:YE HTUT
Other - Last Name:LOO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:2430 POCATELLO AVE
Mailing Address - Street 2:
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-4314
Mailing Address - Country:US
Mailing Address - Phone:415-694-2492
Mailing Address - Fax:
Practice Address - Street 1:2430 POCATELLO AVE
Practice Address - Street 2:
Practice Address - City:ROWLAND HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91748-4314
Practice Address - Country:US
Practice Address - Phone:415-694-2492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-14
Last Update Date:2017-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA67561183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist