Provider Demographics
NPI:1740882604
Name:HUYNH, VAN
Entity type:Individual
Prefix:
First Name:VAN
Middle Name:
Last Name:HUYNH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18140 VILLAGE MART DR
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1413
Mailing Address - Country:US
Mailing Address - Phone:301-774-6304
Mailing Address - Fax:844-411-6240
Practice Address - Street 1:18140 VILLAGE MART DR
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1413
Practice Address - Country:US
Practice Address - Phone:301-774-6304
Practice Address - Fax:844-411-6240
Is Sole Proprietor?:No
Enumeration Date:2020-11-14
Last Update Date:2020-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist