Healthcare Provider Details

I. General information

NPI: 1275494882
Provider Name (Legal Business Name): TOU V THAO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2025
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 TIERRA ST NE APT H
ALBUQUERQUE NM
87111-6128
US

IV. Provider business mailing address

6001 TIERRA ST NE APT H
ALBUQUERQUE NM
87111-6128
US

V. Phone/Fax

Practice location:
  • Phone: 918-704-7773
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number127070
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: