Provider Demographics
NPI:1770188104
Name:HUYNH, SI TIEN (PHARMD)
Entity Type:Individual
Prefix:
First Name:SI
Middle Name:TIEN
Last Name:HUYNH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:MR
Other - First Name:SI
Other - Middle Name:TIEN
Other - Last Name:HUYNH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:160 RESERVOIR ST
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:MA
Mailing Address - Zip Code:01520-1270
Mailing Address - Country:US
Mailing Address - Phone:508-829-7631
Mailing Address - Fax:
Practice Address - Street 1:160 RESERVOIR ST
Practice Address - Street 2:
Practice Address - City:HOLDEN
Practice Address - State:MA
Practice Address - Zip Code:01520-1270
Practice Address - Country:US
Practice Address - Phone:508-829-7631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH25122183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist