Provider Demographics
NPI:1932225307
Name:TA, PHUONG (CPHT)
Entity Type:Individual
Prefix:
First Name:PHUONG
Middle Name:
Last Name:TA
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5048 MURIEL LN
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34653-4852
Mailing Address - Country:US
Mailing Address - Phone:727-457-7961
Mailing Address - Fax:727-943-8256
Practice Address - Street 1:1640 US HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:HOLIDAY
Practice Address - State:FL
Practice Address - Zip Code:34691-5605
Practice Address - Country:US
Practice Address - Phone:727-938-3731
Practice Address - Fax:727-943-8256
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL270101031160378183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0556050041Medicare NSC
FL0556050041Medicare ID - Type Unspecified