Provider Demographics
NPI:1932674603
Name:VU, HUYEN THI-MONG (RPH)
Entity Type:Individual
Prefix:
First Name:HUYEN
Middle Name:THI-MONG
Last Name:VU
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HILLTOP DR APT 36
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-2816
Mailing Address - Country:US
Mailing Address - Phone:408-896-7990
Mailing Address - Fax:
Practice Address - Street 1:1145 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-4357
Practice Address - Country:US
Practice Address - Phone:530-528-0478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79518183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA93374052A93358Medicaid