Provider Demographics
NPI:1700166352
Name:BUI, THAO THIEN (PHARM D)
Entity Type:Individual
Prefix:
First Name:THAO
Middle Name:THIEN
Last Name:BUI
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2610 NORTHAMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-7907
Mailing Address - Country:US
Mailing Address - Phone:407-435-9417
Mailing Address - Fax:
Practice Address - Street 1:2610 NORTHAMPTON AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-7907
Practice Address - Country:US
Practice Address - Phone:407-435-9417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS43873183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist