Provider Demographics
NPI:1669076717
Name:THAN, YEN KIM (RPH)
Entity type:Individual
Prefix:
First Name:YEN
Middle Name:KIM
Last Name:THAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13802 HIGHWAY 6
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:TX
Mailing Address - Zip Code:77517-3416
Mailing Address - Country:US
Mailing Address - Phone:409-925-0164
Mailing Address - Fax:409-925-7260
Practice Address - Street 1:13802 HIGHWAY 6
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:TX
Practice Address - Zip Code:77517-3416
Practice Address - Country:US
Practice Address - Phone:409-925-0164
Practice Address - Fax:409-925-7260
Is Sole Proprietor?:No
Enumeration Date:2020-11-29
Last Update Date:2020-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX60733183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist