Healthcare Provider Details

I. General information

NPI: 1104757566
Provider Name (Legal Business Name): JOHN THAI RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 NORTHPOINT VILLAGE CTR
RESTON VA
20194-1190
US

IV. Provider business mailing address

16 PALMER CT
STERLING VA
20165-5714
US

V. Phone/Fax

Practice location:
  • Phone: 703-437-0037
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202223604
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: