Provider Demographics
NPI:1962007195
Name:NGUYEN, TOM HOC-THAI
Entity Type:Individual
Prefix:
First Name:TOM
Middle Name:HOC-THAI
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15270 HIGHWAY 105 W
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77356-5684
Mailing Address - Country:US
Mailing Address - Phone:936-588-0666
Mailing Address - Fax:936-588-0688
Practice Address - Street 1:15270 HIGHWAY 105 W
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77356-5684
Practice Address - Country:US
Practice Address - Phone:936-588-0666
Practice Address - Fax:936-588-0688
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX42275183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist