Provider Demographics
NPI:1679090021
Name:LAI, TUNG THANH (RPH)
Entity Type:Individual
Prefix:
First Name:TUNG
Middle Name:THANH
Last Name:LAI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8963 W OCOTILLO RD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85305-2057
Mailing Address - Country:US
Mailing Address - Phone:714-837-3088
Mailing Address - Fax:
Practice Address - Street 1:9040 W PEORIA AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-6406
Practice Address - Country:US
Practice Address - Phone:623-979-2180
Practice Address - Fax:623-979-1881
Is Sole Proprietor?:No
Enumeration Date:2017-08-26
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS022815183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist