MEDICARE: THIEN THU T HUYNH 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	72667	CA

General Provider Information

NPI Number	:	1942713854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THIEN THU T HUYNH PHARMD

Provider Business Mailing Address
First Line	:	22456 BARTON RD
Second Line	:
City	:	GRAND TERRACE
State	:	CA
Zip	:	92313-5009
Country	:	US
Telephone Number	:	909-824-2619
Fax Number	:

Provider Business Practice Location Address
First Line	:	22456 BARTON RD
Second Line	:
City	:	GRAND TERRACE
State	:	CA
Zip	:	92313-5009
Country	:	US
Telephone Number	:	909-824-2619
Fax Number	:

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

Provider Enumeration Date	:	11/14/2017
Last Update Date	:	11/14/2017

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