Provider Demographics
NPI:1922756709
Name:THAI, TAN
Entity Type:Individual
Prefix:
First Name:TAN
Middle Name:
Last Name:THAI
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 1:978 GALLOWAY RD
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:OH
Mailing Address - Zip Code:43119-8293
Mailing Address - Country:US
Mailing Address - Phone:614-853-3498
Mailing Address - Fax:614-853-4022
Practice Address - Street 1:978 GALLOWAY RD
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:OH
Practice Address - Zip Code:43119-8293
Practice Address - Country:US
Practice Address - Phone:614-853-3498
Practice Address - Fax:614-853-4022
Is Sole Proprietor?:No
Enumeration Date:2022-03-11
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH033222171835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist