Provider Demographics
NPI:1639502362
Name:HUYNH, TIEN T (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:TIEN
Middle Name:T
Last Name:HUYNH
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 GALLERIA DR
Mailing Address - Street 2:#6
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95134-2431
Mailing Address - Country:US
Mailing Address - Phone:408-515-0463
Mailing Address - Fax:
Practice Address - Street 1:418 GALLERIA DR
Practice Address - Street 2:#6
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95134-2431
Practice Address - Country:US
Practice Address - Phone:408-515-0463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66022183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist