Provider Demographics
NPI:1750672267
Name:PHAN, THUY NGUYEN
Entity Type:Individual
Prefix:MS
First Name:THUY
Middle Name:NGUYEN
Last Name:PHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20225 SW TUALATIN VALLEY HWY
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97006-2302
Mailing Address - Country:US
Mailing Address - Phone:503-649-1576
Mailing Address - Fax:503-649-3553
Practice Address - Street 1:20225 SW TUALATIN VALLEY HWY
Practice Address - Street 2:
Practice Address - City:ALOHA
Practice Address - State:OR
Practice Address - Zip Code:97006-2302
Practice Address - Country:US
Practice Address - Phone:503-649-1576
Practice Address - Fax:503-649-3553
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-02
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR9748183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist