MEDICARE: AN TIEU MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	059747	TX

General Provider Information

NPI Number	:	1023621588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AN TIEU MA

Provider Business Mailing Address
First Line	:	6520 BROADWAY ST APT 1223
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77581-7725
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7102 FM 1464 RD
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-6429
Country	:	US
Telephone Number	:	281-494-1984
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2020
Last Update Date	:	08/25/2020

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Directions to “ AN TIEU MA ” Practice Location

Language	Start Address	Practice Location

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