Provider Demographics
NPI:1003332263
Name:TRUONG, DAN DOAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:DOAN
Last Name:TRUONG
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 1:11700 MUKILTEO SPEEDWAY STE 500
Mailing Address - Street 2:
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-5435
Mailing Address - Country:US
Mailing Address - Phone:808-636-4078
Mailing Address - Fax:
Practice Address - Street 1:11700 MUKILTEO SPEEDWAY STE 500
Practice Address - Street 2:
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-5435
Practice Address - Country:US
Practice Address - Phone:425-514-0620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-19
Last Update Date:2017-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60769570183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist