Provider Demographics
NPI:1578163952
Name:PHUNG, THOI TAN (PHARM D)
Entity Type:Individual
Prefix:
First Name:THOI
Middle Name:TAN
Last Name:PHUNG
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1724 W UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-2800
Mailing Address - Country:US
Mailing Address - Phone:956-381-1891
Mailing Address - Fax:956-318-0276
Practice Address - Street 1:1724 W UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-2848
Practice Address - Country:US
Practice Address - Phone:956-381-1891
Practice Address - Fax:956-318-0276
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40779183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist