Provider Demographics
NPI:1336416353
Name:DO, TIEN SO
Entity Type:Individual
Prefix:MRS
First Name:TIEN
Middle Name:SO
Last Name:DO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41298 RESERVOIR RD
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-6361
Mailing Address - Country:US
Mailing Address - Phone:703-885-5546
Mailing Address - Fax:703-885-5564
Practice Address - Street 1:14390 CHANTILLY CROSSING LN
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-2117
Practice Address - Country:US
Practice Address - Phone:703-885-5546
Practice Address - Fax:703-885-5564
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-18
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02020108451835P0018X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist