Provider Demographics
NPI:1508688110
Name:HUYNH, QUANG T
Entity type:Individual
Prefix:
First Name:QUANG
Middle Name:T
Last Name:HUYNH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ULTRA WAY APT A10
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-1581
Mailing Address - Country:US
Mailing Address - Phone:518-888-6578
Mailing Address - Fax:
Practice Address - Street 1:1 ULTRA WAY APT A10
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1581
Practice Address - Country:US
Practice Address - Phone:518-888-6545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-26
Last Update Date:2024-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071722183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist