Provider Demographics
NPI:1336922343
Name:NGUYEN, MI THAO (PHARMD)
Entity Type:Individual
Prefix:
First Name:MI
Middle Name:THAO
Last Name:NGUYEN
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 1:120 E SONTERRA BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3982
Mailing Address - Country:US
Mailing Address - Phone:210-404-9006
Mailing Address - Fax:210-404-2173
Practice Address - Street 1:120 E SONTERRA BLVD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3982
Practice Address - Country:US
Practice Address - Phone:210-404-9006
Practice Address - Fax:210-404-2173
Is Sole Proprietor?:No
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72882183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist