Provider Demographics
NPI:1518754803
Name:THAI, KHANH-LONG (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KHANH-LONG
Middle Name:
Last Name:THAI
Suffix:
Gender:
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 W FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-1939
Mailing Address - Country:US
Mailing Address - Phone:626-674-6718
Mailing Address - Fax:
Practice Address - Street 1:2476 HUNTINGTON DR
Practice Address - Street 2:
Practice Address - City:SAN MARINO
Practice Address - State:CA
Practice Address - Zip Code:91108-2643
Practice Address - Country:US
Practice Address - Phone:626-674-6718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV15918183500000X
CA53678183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist