MEDICARE: DR. JOSEPHINE A THAN PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	48171	TX

General Provider Information

NPI Number	:	1013565639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPHINE A THAN PHARMD

Provider Business Mailing Address
First Line	:	PO BOX 2229
Second Line	:
City	:	CANYON LAKE
State	:	TX
Zip	:	78133-0009
Country	:	US
Telephone Number	:	830-964-3615
Fax Number	:

Provider Business Practice Location Address
First Line	:	1395 SATTLER RD STE 8
Second Line	:
City	:	CANYON LAKE
State	:	TX
Zip	:	78132-2296
Country	:	US
Telephone Number	:	830-964-3615
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/27/2019
Last Update Date	:	05/29/2024

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