Thang Ngoc Ton Vu
Individual provider Active NPI Pharmacist · Interlachen, FL
NPI 1134723299 · NPPES record last updated Nov 29, 2020
Key facts
- NPI
- 1134723299
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- PS59061 (FL)
- Practice address
- 1141 State Road 20
Interlachen, FL 32148-5406 - Phone
- (386) 684-4991
- Fax
- (386) 684-3029
- NPI assigned
- Nov 29, 2020
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS59061 | FL | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PS59061 | FL | Yes |
Addresses
Primary practice location
1141 State Road 20
Interlachen, FL 32148-5406
Mailing address
1141 State Road 20
Interlachen, FL 32148-5406
Phone (386) 684-4991
Other providers in Interlachen, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 29, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.