Provider Demographics
NPI:1801489729
Name:ANTOLIN, THUY THI (PHARMD)
Entity type:Individual
Prefix:DR
First Name:THUY
Middle Name:THI
Last Name:ANTOLIN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6456 WRIGLEY CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-7324
Mailing Address - Country:US
Mailing Address - Phone:702-883-2155
Mailing Address - Fax:
Practice Address - Street 1:3699 HWAY 95
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-9118
Practice Address - Country:US
Practice Address - Phone:928-704-5064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-12
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV20742183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist