1003949462 NPI number — PHAT DAT CORPORATION

Table of content: (NPI 1003949462)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003949462 NPI number — PHAT DAT CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHAT DAT CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NHA TRANG PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003949462
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6988 WILCREST DR
Provider Second Line Business Mailing Address:
A-1
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77072-2625
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-530-4500
Provider Business Mailing Address Fax Number:
281-530-4502

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6988 WILCREST DR
Provider Second Line Business Practice Location Address:
A-1
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77072-2625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-530-4500
Provider Business Practice Location Address Fax Number:
281-530-4502
Provider Enumeration Date:
03/14/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LE
Authorized Official First Name:
KENNY
Authorized Official Middle Name:
THANG
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
281-530-4500

Provider Taxonomy Codes

  • Taxonomy code: 183500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)