Healthcare Provider Details

I. General information

NPI: 1093079568
Provider Name (Legal Business Name): STEVEN QUOC THAI PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2012
Last Update Date: 06/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1516 JEFFERSON HWY
NEW ORLEANS LA
70121-2429
US

IV. Provider business mailing address

4912 CONSTANCE ST
NEW ORLEANS LA
70115-1725
US

V. Phone/Fax

Practice location:
  • Phone: 504-899-9311
  • Fax:
Mailing address:
  • Phone: 203-583-1903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number019444
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: