MEDICARE: DR. THI TUONG TA 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	59979	TX

General Provider Information

NPI Number	:	1467065938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THI TUONG TA PHARMD

Provider Business Mailing Address
First Line	:	13260 JOSEY LN
Second Line	:
City	:	FARMERS BRANCH
State	:	TX
Zip	:	75234-4973
Country	:	US
Telephone Number	:	972-247-3421
Fax Number	:	972-247-1469

Provider Business Practice Location Address
First Line	:	13260 JOSEY LN
Second Line	:
City	:	FARMERS BRANCH
State	:	TX
Zip	:	75234-4973
Country	:	US
Telephone Number	:	972-247-3421
Fax Number	:	972-247-1469

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

Provider Enumeration Date	:	08/25/2020
Last Update Date	:	08/25/2020

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