Healthcare Provider Details

I. General information

NPI: 1891027124
Provider Name (Legal Business Name): THUY HUYNH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2010
Last Update Date: 02/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5342 DUDLEY BLVD
MCCLELLAN CA
95652-1012
US

IV. Provider business mailing address

2668 ROXBY WAY
ROSEVILLE CA
95747-8852
US

V. Phone/Fax

Practice location:
  • Phone: 916-561-7430
  • Fax:
Mailing address:
  • Phone: 916-787-2005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number57007
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: