Healthcare Provider Details

I. General information

NPI: 1396094256
Provider Name (Legal Business Name): THANH-MAI THI MAI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2012
Last Update Date: 09/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 NW MAYNARD RD
CARY NC
27513-8826
US

IV. Provider business mailing address

2323 NW MAYNARD RD
CARY NC
27513-8826
US

V. Phone/Fax

Practice location:
  • Phone: 919-462-3432
  • Fax:
Mailing address:
  • Phone: 919-462-3432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17059
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: