Provider Demographics
NPI:1356942676
Name:HUYNH, THAO LE PHUONG (RPH)
Entity type:Individual
Prefix:MRS
First Name:THAO
Middle Name:LE PHUONG
Last Name:HUYNH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:130 SUNDANCE PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-7935
Mailing Address - Country:US
Mailing Address - Phone:512-828-0557
Mailing Address - Fax:512-828-0560
Practice Address - Street 1:130 SUNDANCE PKWY STE 300
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-7935
Practice Address - Country:US
Practice Address - Phone:512-828-0557
Practice Address - Fax:512-828-0560
Is Sole Proprietor?:No
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA015537183500000X
TX46726183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist