Basic Information
| Provider Information | |||||||||
| NPI: | 1346831773 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THAI | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | WARREN | ||||||||
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| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25557 FRETTON SQ | ||||||||
| Address2: | |||||||||
| City: | SOUTH RIDING | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201525324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7033991389 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2912 CHAIN BRIDGE RD | ||||||||
| Address2: | |||||||||
| City: | OAKTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221243001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7032814444 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2021 | ||||||||
| LastUpdateDate: | 01/28/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 0202213232 | VA | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.