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General NPI Number Information
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NPI Number | 1073334280
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Entity Type | Individual
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Provider Name | THI MINH TAM LUONG
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Gender | Female
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Dates
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Enumeration Date | 10/21/2024
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 1915 BROADWAY ST STE 101
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City | SAN ANTONIO
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State | TX
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Zip | 78215-1133
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Country | US
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Telephone | 210-806-8741
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Fax |
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Provider Business Mailing Address
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Address Line | 7351 MONETS GDN
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City | SAN ANTONIO
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State | TX
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Zip | 78218-3121
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Country | US
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Telephone | 774-641-1605
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PH241712
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 74506
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License Number State | TX
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