Provider Demographics
NPI:1831421569
Name:THAI, PHILLIP NHUOC (BS)
Entity type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:NHUOC
Last Name:THAI
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:107-16 CONTINENTAL AVEUE
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4549
Mailing Address - Country:US
Mailing Address - Phone:718-793-2905
Mailing Address - Fax:718-793-3186
Practice Address - Street 1:10716 CONTINENTAL AVE
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4725
Practice Address - Country:US
Practice Address - Phone:718-793-2905
Practice Address - Fax:718-793-3186
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-05
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY043470183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01958043Medicaid