Provider Demographics
NPI:1205158516
Name:HUYNH, HUNG T (BS PHARM)
Entity type:Individual
Prefix:MR
First Name:HUNG
Middle Name:T
Last Name:HUYNH
Suffix:
Gender:M
Credentials:BS PHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4477 VERSATILE CT SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49418-8774
Mailing Address - Country:US
Mailing Address - Phone:616-531-3342
Mailing Address - Fax:
Practice Address - Street 1:701 68TH ST SW
Practice Address - Street 2:
Practice Address - City:BYRON CENTER
Practice Address - State:MI
Practice Address - Zip Code:49315-8372
Practice Address - Country:US
Practice Address - Phone:616-281-8212
Practice Address - Fax:616-281-0523
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-28
Last Update Date:2010-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302032469183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302032469OtherSTATE LICENSE