Healthcare Provider Details

I. General information

NPI: 1356997647
Provider Name (Legal Business Name): PHUONG THI HUYNH PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2019
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 CENTURY AVE
KALAMAZOO MI
49006-5714
US

IV. Provider business mailing address

10659 BILTMORE LN
PORTAGE MI
49002-8419
US

V. Phone/Fax

Practice location:
  • Phone: 269-743-2308
  • Fax: 269-743-2299
Mailing address:
  • Phone: 734-331-7571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302411977
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: