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General NPI Number Information
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NPI Number | 1831421569
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Entity Type | Individual
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Provider Name | PHILLIP NHUOC THAI BS
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Gender | Male
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Dates
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Enumeration Date | 02/05/2010
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Last Update Date | 04/12/2010
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Provider Practice Location Address
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Address Line | 10716 CONTINENTAL AVE
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City | FOREST HILLS
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State | NY
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Zip | 11375-4725
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Country | US
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Telephone | 718-793-2905
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Fax | 718-793-3186
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Provider Business Mailing Address
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Address Line | 107-16 CONTINENTAL AVEUE
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City | FOREST HILLS
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State | NY
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Zip | 11375-4549
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Country | US
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Telephone | 718-793-2905
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Fax | 718-793-3186
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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 | 043470
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License Number State | NY
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