Provider Demographics
NPI:1578264123
Name:DINH, ANDY
Entity Type:Individual
Prefix:
First Name:ANDY
Middle Name:
Last Name:DINH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8979 NE TENNYSON ST APT 316
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97006-2927
Mailing Address - Country:US
Mailing Address - Phone:601-863-9831
Mailing Address - Fax:
Practice Address - Street 1:1815 4TH ST
Practice Address - Street 2:
Practice Address - City:TILLAMOOK
Practice Address - State:OR
Practice Address - Zip Code:97141-2210
Practice Address - Country:US
Practice Address - Phone:503-842-5934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-10
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0019402183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist