Provider Demographics
NPI:1861197014
Name:HUYNH, TONY BAO (PHARMD)
Entity type:Individual
Prefix:
First Name:TONY
Middle Name:BAO
Last Name:HUYNH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12835 CHUKAR CIR APT D
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-5879
Mailing Address - Country:US
Mailing Address - Phone:316-993-9089
Mailing Address - Fax:
Practice Address - Street 1:220 W STOCKTON ST
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-4951
Practice Address - Country:US
Practice Address - Phone:209-536-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-04
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87743183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist