Active NPI
Thierry Phouthavong, PHARM.D.
- Pharmacist
- Orlando, FL
National Provider Identifier
1932650587
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS55771
- Practice address
- 13800 Veterans Way
Orlando, FL 32827-7403 - Phone
- (407) 631-2906
- NPI assigned
- Oct 19, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PS55771 | FL | Primary |
Addresses
Primary practice location
13800 Veterans Way
Orlando, FL 32827-7403
Mailing address
8426 Lantana Dr
Largo, FL 33777-3515
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS55771 | FL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1476835200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1476835200000",
"number": "1932650587",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8426 LANTANA DR",
"city": "LARGO",
"state": "FL",
"postal_code": "337773515"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13800 VETERANS WAY",
"city": "ORLANDO",
"state": "FL",
"postal_code": "328277403",
"telephone_number": "407-631-2906"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHOUTHAVONG",
"first_name": "THIERRY",
"credential": "PHARM.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-10-19",
"last_updated": "2016-10-19",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS55771",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Orlando, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.