Provider Demographics
NPI:1245707819
Name:THAI, AILEEN (PHARMD)
Entity type:Individual
Prefix:
First Name:AILEEN
Middle Name:
Last Name:THAI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1889 JUNEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95132-1625
Mailing Address - Country:US
Mailing Address - Phone:408-568-2730
Mailing Address - Fax:
Practice Address - Street 1:9400 N NAME UNO
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-3528
Practice Address - Country:US
Practice Address - Phone:408-848-8620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-31
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA78863390200000X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program