Provider Demographics
NPI:1689671752
Name:DOAN, TUAN MANH (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:TUAN
Middle Name:MANH
Last Name:DOAN
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1692 TULLY RD
Mailing Address - Street 2:STE 7
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122-2550
Mailing Address - Country:US
Mailing Address - Phone:408-238-6319
Mailing Address - Fax:408-238-6363
Practice Address - Street 1:1692 TULLY RD
Practice Address - Street 2:STE 7
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-2550
Practice Address - Country:US
Practice Address - Phone:408-238-6319
Practice Address - Fax:408-238-6363
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH42583183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA361500Medicaid