Provider Demographics
NPI:1891076261
Name:THONGDARA, JENNY PENG (PHARMD)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:PENG
Last Name:THONGDARA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:
Other - Last Name:PENG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10301 STELLA LINK RD STE C
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-5447
Mailing Address - Country:US
Mailing Address - Phone:888-482-5327
Mailing Address - Fax:
Practice Address - Street 1:10301 STELLA LINK RD STE C
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-5447
Practice Address - Country:US
Practice Address - Phone:888-482-5327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-30
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50370183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist