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General NPI Number Information
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NPI Number | 1851270276
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Entity Type | Individual
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Provider Name | THAO ANH THI LA
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Gender | Female
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Dates
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Enumeration Date | 08/29/2025
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Last Update Date | 08/29/2025
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Provider Practice Location Address
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Address Line | 300 S SERVICE RD
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City | WEST MEMPHIS
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State | AR
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Zip | 72301-1726
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Country | US
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Telephone | 870-732-0283
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Fax |
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Provider Business Mailing Address
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Address Line | 80 N MENDENHALL RD
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City | MEMPHIS
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State | TN
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Zip | 38117-2631
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Country | US
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Telephone | 901-218-5255
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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 | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 49027
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | PD17470
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License Number State | AR
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