Provider Demographics
NPI:1205433810
Name:LA, TONY HIEU (PHARMD)
Entity type:Individual
Prefix:
First Name:TONY
Middle Name:HIEU
Last Name:LA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 S. ANITA DR. 2ND FLOOR
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868
Mailing Address - Country:US
Mailing Address - Phone:866-558-2775
Mailing Address - Fax:
Practice Address - Street 1:132 S ANITA DR STE 210
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3317
Practice Address - Country:US
Practice Address - Phone:877-778-3773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-06
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0016513183500000X
CA73904183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist