Provider Demographics
NPI:1922609684
Name:HUYNH, CHARLIE TUNG (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:CHARLIE
Middle Name:TUNG
Last Name:HUYNH
Suffix:
Gender:M
Credentials:PHARMACIST
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 21164
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34204-1164
Mailing Address - Country:US
Mailing Address - Phone:941-567-0288
Mailing Address - Fax:
Practice Address - Street 1:5315 CORTEZ RD W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-2814
Practice Address - Country:US
Practice Address - Phone:941-795-1807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-07
Last Update Date:2020-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS36234183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist