MEDICARE: TAM THANH NGAC PHARMD

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	65220	TX

General Provider Information

NPI Number	:	1790330173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAM THANH NGAC PHARMD

Provider Business Mailing Address
First Line	:	616 MEMORIAL HEIGHTS DR APT 5106
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77007-6091
Country	:	US
Telephone Number	:	832-310-9828
Fax Number	:

Provider Business Practice Location Address
First Line	:	3745 WESTHEIMER RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77027-5227
Country	:	US
Telephone Number	:	713-629-0703
Fax Number	:

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

Provider Enumeration Date	:	08/02/2019
Last Update Date	:	08/02/2019

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