Provider Demographics
NPI:1730417908
Name:MAI, LOAN PHUONG (PHARM D)
Entity type:Individual
Prefix:MS
First Name:LOAN
Middle Name:PHUONG
Last Name:MAI
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1506 ELDRIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-1759
Mailing Address - Country:US
Mailing Address - Phone:281-558-4565
Mailing Address - Fax:
Practice Address - Street 1:1506 ELDRIDGE PKWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-1759
Practice Address - Country:US
Practice Address - Phone:281-558-4565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-30
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX43510183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist