Provider Demographics
NPI:1548860695
Name:NGUYEN, BAO THAI (PHARMD)
Entity type:Individual
Prefix:DR
First Name:BAO
Middle Name:THAI
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:RYAN
Other - Middle Name:THAI
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10781 TOEPPERWEIN RD
Mailing Address - Street 2:
Mailing Address - City:CONVERSE
Mailing Address - State:TX
Mailing Address - Zip Code:78109-2561
Mailing Address - Country:US
Mailing Address - Phone:210-672-6812
Mailing Address - Fax:
Practice Address - Street 1:10781 TOEPPERWEIN RD
Practice Address - Street 2:
Practice Address - City:CONVERSE
Practice Address - State:TX
Practice Address - Zip Code:78109-2561
Practice Address - Country:US
Practice Address - Phone:210-672-6812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62525183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist