Provider Demographics
NPI:1750659686
Name:MAI, TONY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TONY
Middle Name:
Last Name:MAI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6700 TOPANGA CANYON BLVD
Mailing Address - Street 2:T2143
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-2624
Mailing Address - Country:US
Mailing Address - Phone:818-746-9922
Mailing Address - Fax:
Practice Address - Street 1:6700 TOPANGA CANYON BLVD
Practice Address - Street 2:T2143
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-2624
Practice Address - Country:US
Practice Address - Phone:818-746-9922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-07
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66681183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist