Provider Demographics
NPI:1558631333
Name:THAI, PHU TRUNG (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:PHU
Middle Name:TRUNG
Last Name:THAI
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 1:11290 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-5815
Mailing Address - Country:US
Mailing Address - Phone:804-360-8912
Mailing Address - Fax:804-360-8912
Practice Address - Street 1:11290 W BROAD ST
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-5815
Practice Address - Country:US
Practice Address - Phone:804-360-8912
Practice Address - Fax:804-360-8912
Is Sole Proprietor?:No
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202206659183500000X
NH3417183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist