Provider Demographics
NPI:1598779159
Name:HA, XUANPHUNG THI (RPH)
Entity Type:Individual
Prefix:MRS
First Name:XUANPHUNG
Middle Name:THI
Last Name:HA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:PHOEBE
Other - Middle Name:
Other - Last Name:HA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:422 SONORA CIR
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-8505
Mailing Address - Country:US
Mailing Address - Phone:909-307-1710
Mailing Address - Fax:
Practice Address - Street 1:11201 BENTON ST
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92357-1000
Practice Address - Country:US
Practice Address - Phone:909-825-7084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV15185183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist