Provider Demographics
NPI:1790058881
Name:PHAN, HUYEN THI
Entity Type:Individual
Prefix:
First Name:HUYEN
Middle Name:THI
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 1:12247 2ND AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98168-2029
Mailing Address - Country:US
Mailing Address - Phone:404-641-9039
Mailing Address - Fax:
Practice Address - Street 1:17404 MERIDIAN E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-6234
Practice Address - Country:US
Practice Address - Phone:253-445-7873
Practice Address - Fax:253-445-7867
Is Sole Proprietor?:No
Enumeration Date:2012-02-20
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60134512183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist