Healthcare Provider Details

I. General information

NPI: 1285554956
Provider Name (Legal Business Name): QUI PHU ON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2405 PASS RD
BILOXI MS
39531-2111
US

IV. Provider business mailing address

9495 PRINGLE AVE
DIBERVILLE MS
39540-5433
US

V. Phone/Fax

Practice location:
  • Phone: 228-388-3458
  • Fax:
Mailing address:
  • Phone: 228-280-9346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE-102488
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: