Provider Demographics
NPI:1851270276
Name:LA, THAO ANH THI
Entity type:Individual
Prefix:
First Name:THAO ANH
Middle Name:THI
Last Name:LA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:THAOANH
Other - Middle Name:THI
Other - Last Name:LA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:80 N MENDENHALL RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-2631
Mailing Address - Country:US
Mailing Address - Phone:901-218-5255
Mailing Address - Fax:
Practice Address - Street 1:300 S SERVICE RD
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-1726
Practice Address - Country:US
Practice Address - Phone:870-732-0283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-29
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN490271835P0018X
ARPD174701835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist