Provider Demographics
NPI:1134775810
Name:NGUYEN, TOAN THANH (DPH)
Entity type:Individual
Prefix:
First Name:TOAN
Middle Name:THANH
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4413 S 173RD EAST AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74134-7356
Mailing Address - Country:US
Mailing Address - Phone:918-605-8626
Mailing Address - Fax:
Practice Address - Street 1:4851 W HOUSTON ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-4671
Practice Address - Country:US
Practice Address - Phone:918-505-6094
Practice Address - Fax:918-505-6095
Is Sole Proprietor?:No
Enumeration Date:2019-08-17
Last Update Date:2019-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12418183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist