Provider Demographics
NPI:1770022626
Name:HUYNH, THAO TRI THANH (RPH)
Entity Type:Individual
Prefix:
First Name:THAO
Middle Name:TRI THANH
Last Name:HUYNH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 GILMAN ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94710-1532
Mailing Address - Country:US
Mailing Address - Phone:510-528-8274
Mailing Address - Fax:
Practice Address - Street 1:1050 GILMAN ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94710-1532
Practice Address - Country:US
Practice Address - Phone:510-528-8274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA76260183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist