Provider Demographics
NPI:1003193004
Name:TRUONG, KATHY (PHARM D)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:TRUONG
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4029 43RD STREET
Mailing Address - Street 2:SUITE 700
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-1510
Mailing Address - Country:US
Mailing Address - Phone:619-521-9753
Mailing Address - Fax:619-521-4837
Practice Address - Street 1:4029 43RD STREET
Practice Address - Street 2:SUITE 700
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-1510
Practice Address - Country:US
Practice Address - Phone:619-521-9753
Practice Address - Fax:619-521-4837
Is Sole Proprietor?:No
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61721183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist