Provider Demographics
NPI:1235570730
Name:BUI, TAM QUANG (PHARMD)
Entity type:Individual
Prefix:
First Name:TAM
Middle Name:QUANG
Last Name:BUI
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 1:2330 NEVADA AVE
Mailing Address - Street 2:APT 708
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-1413
Mailing Address - Country:US
Mailing Address - Phone:626-251-8070
Mailing Address - Fax:
Practice Address - Street 1:2300 EAST LOHMAN AVE.
Practice Address - Street 2:WALGREENS PHARMACY:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001
Practice Address - Country:US
Practice Address - Phone:575-647-2506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-12
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00007921183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist