MEDICARE: THU J HUYNH RPH

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	17119	IA

General Provider Information

NPI Number	:	1275641946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THU J HUYNH RPH

Provider Business Mailing Address
First Line	:	3239 TERRACE BEACH DR
Second Line	:
City	:	VALLEJO
State	:	CA
Zip	:	94591-6347
Country	:	US
Telephone Number	:	707-562-8272
Fax Number	:	707-562-8304

Provider Business Practice Location Address
First Line	:	3239 TERRACE BEACH DR
Second Line	:
City	:	VALLEJO
State	:	CA
Zip	:	94591-6347
Country	:	US
Telephone Number	:	707-562-8272
Fax Number	:	707-562-8304

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

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	07/08/2007

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