Provider Demographics
NPI:1447550074
Name:HUYNH, HONG THI KIM (PHARMD)
Entity type:Individual
Prefix:DR
First Name:HONG
Middle Name:THI KIM
Last Name:HUYNH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411-C SOUTH MAIN STREET
Mailing Address - Street 2:CVS/PHARMACY
Mailing Address - City:ROLESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27571
Mailing Address - Country:US
Mailing Address - Phone:919-554-0925
Mailing Address - Fax:919-570-7806
Practice Address - Street 1:411-C SOUTH MAIN STREET
Practice Address - Street 2:CVS/PHARMACY
Practice Address - City:ROLESVILLE
Practice Address - State:NC
Practice Address - Zip Code:27571
Practice Address - Country:US
Practice Address - Phone:919-554-0925
Practice Address - Fax:919-570-7806
Is Sole Proprietor?:No
Enumeration Date:2010-10-29
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17567183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0928994Medicaid