MEDICARE: QUYNH THIEU

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	PS56825	FL

General Provider Information

NPI Number	:	1588180194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	QUYNH THIEU

Provider Business Mailing Address
First Line	:	10075 GATE PKWY N APT 311
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-4417
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2845 COUNTY ROAD 210 W
Second Line	:
City	:	SAINT JOHNS
State	:	FL
Zip	:	32259-2016
Country	:	US
Telephone Number	:	904-230-3933
Fax Number	:

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

Provider Enumeration Date	:	08/15/2017
Last Update Date	:	08/15/2017

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Directions to “ QUYNH THIEU ” Practice Location

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