Provider Demographics
NPI:1871470559
Name:THAN, MINH
Entity type:Individual
Prefix:
First Name:MINH
Middle Name:
Last Name:THAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 WILLIAM T MORRISSEY BLVD UNIT 1506
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02125-3366
Mailing Address - Country:US
Mailing Address - Phone:857-204-6602
Mailing Address - Fax:
Practice Address - Street 1:231 MASSACHUSETTS AVE APT 1506
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-3500
Practice Address - Country:US
Practice Address - Phone:857-204-6602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-16
Last Update Date:2025-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH1002610183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist