1104030543 NPI number — MRS. ANHUE THI DOAN RPH

Table of content: MRS. ANHUE THI DOAN RPH (NPI 1104030543)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104030543 NPI number — MRS. ANHUE THI DOAN RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOAN
Provider First Name:
ANHUE
Provider Middle Name:
THI
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RPH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NGUYEN
Provider Other First Name:
ANHUE
Provider Other Middle Name:
THI
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RPH
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1104030543
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2702 GOSFORD ROAD
Provider Second Line Business Mailing Address:
APT C
Provider Business Mailing Address City Name:
BAKERSFIELD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93309
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-374-1500
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2702 GOSFORD RD APT C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAKERSFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93309-8865
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-378-1500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  39872 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0561894 . This is a "NABP PROVIDER SERVICES" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 451580 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 39872 . This is a "PHARMACY LICENSE NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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