Provider Demographics
NPI:1558811588
Name:MOUA, HUE THENG (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:HUE
Middle Name:THENG
Last Name:MOUA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:HUE
Other - Middle Name:THENG
Other - Last Name:MOUA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:164 W JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94544-1810
Mailing Address - Country:US
Mailing Address - Phone:510-781-0900
Mailing Address - Fax:
Practice Address - Street 1:164 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94544-1810
Practice Address - Country:US
Practice Address - Phone:510-781-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-13
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA756961183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist