Provider Demographics
NPI:1972225761
Name:HUYNH, NGOC TRAN BAO (PHARMACIST)
Entity Type:Individual
Prefix:MISS
First Name:NGOC
Middle Name:TRAN BAO
Last Name:HUYNH
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2304 GARDEN PARK CT
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013-1358
Mailing Address - Country:US
Mailing Address - Phone:682-230-2054
Mailing Address - Fax:
Practice Address - Street 1:725 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:TX
Practice Address - Zip Code:75652-2676
Practice Address - Country:US
Practice Address - Phone:903-657-7586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71227183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist