MEDICARE: TIEN MY HO 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	82060	CA

General Provider Information

NPI Number	:	1932731551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIEN MY HO PHARMD

Provider Business Mailing Address
First Line	:	15555 E 14TH ST
Second Line	:
City	:	SAN LEANDRO
State	:	CA
Zip	:	94578-1900
Country	:	US
Telephone Number	:	510-276-3979
Fax Number	:

Provider Business Practice Location Address
First Line	:	15555 E 14TH ST STE 400
Second Line	:
City	:	SAN LEANDRO
State	:	CA
Zip	:	94578-1978
Country	:	US
Telephone Number	:	510-276-3979
Fax Number	:

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

Provider Enumeration Date	:	02/11/2020
Last Update Date	:	02/25/2020

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Directions to “ TIEN MY HO PHARMD” Practice Location

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