Healthcare Provider Details

I. General information

NPI: 1952880999
Provider Name (Legal Business Name): MYMY THI DINH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2018
Last Update Date: 08/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 VIRGINIA BEACH BLVD
VIRGINIA BEACH VA
23451-3441
US

IV. Provider business mailing address

824 GREAT MARSH AVE
CHESAPEAKE VA
23320-0660
US

V. Phone/Fax

Practice location:
  • Phone: 757-437-0017
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202217041
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: