Provider Demographics
NPI:1659976579
Name:DANG, HUONG THIEN (PHARMD)
Entity Type:Individual
Prefix:
First Name:HUONG
Middle Name:THIEN
Last Name:DANG
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 1:4322 GLENEAGLES DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-6800
Mailing Address - Country:US
Mailing Address - Phone:817-705-0745
Mailing Address - Fax:
Practice Address - Street 1:5195 LAKE RIDGE PKWY
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-3098
Practice Address - Country:US
Practice Address - Phone:972-522-0395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45577183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist