Healthcare Provider Details

I. General information

NPI: 1841748704
Provider Name (Legal Business Name): PHU TRINH PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2016
Last Update Date: 09/22/2023
Certification Date: 09/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 LONGHORN BLVD STE 102
AUSTIN TX
78758-7624
US

IV. Provider business mailing address

855 MONTGOMERY ST
FORT WORTH TX
76107-2553
US

V. Phone/Fax

Practice location:
  • Phone: 833-428-7284
  • Fax: 833-428-7284
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberPH60671816
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number65904
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: