Provider Demographics
NPI:1851722623
Name:THAI, CHARLIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:CHARLIE
Middle Name:
Last Name:THAI
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:PO BOX 424
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-0011
Mailing Address - Country:US
Mailing Address - Phone:209-241-8000
Mailing Address - Fax:
Practice Address - Street 1:450 N WILBUR AVE
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-2254
Practice Address - Country:US
Practice Address - Phone:509-529-3706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-04
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60340416183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist