Provider Demographics
NPI:1629495197
Name:HAN, TAM THANH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TAM
Middle Name:THANH
Last Name:HAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:FL
Mailing Address - Zip Code:32351-2125
Mailing Address - Country:US
Mailing Address - Phone:850-627-7663
Mailing Address - Fax:850-627-7673
Practice Address - Street 1:1217 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:FL
Practice Address - Zip Code:32351-2125
Practice Address - Country:US
Practice Address - Phone:850-627-7663
Practice Address - Fax:850-627-7673
Is Sole Proprietor?:No
Enumeration Date:2014-03-23
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH027094183500000X
FLPS50005183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist