Provider Demographics
NPI:1801499090
Name:MACH, THIEN THANH (PHARMD)
Entity type:Individual
Prefix:MS
First Name:THIEN
Middle Name:THANH
Last Name:MACH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9600 PARKSOUTH CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-6424
Mailing Address - Country:US
Mailing Address - Phone:407-826-6951
Mailing Address - Fax:
Practice Address - Street 1:9600 PARKSOUTH CT
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-6424
Practice Address - Country:US
Practice Address - Phone:407-826-6951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL39551183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist