Provider Demographics
NPI:1043595499
Name:REYEN, QUANG (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:QUANG
Middle Name:
Last Name:REYEN
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 1:840 OAKDALE RD
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-4509
Mailing Address - Country:US
Mailing Address - Phone:209-571-9075
Mailing Address - Fax:209-571-9052
Practice Address - Street 1:840 OAKDALE RD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-4509
Practice Address - Country:US
Practice Address - Phone:209-571-9075
Practice Address - Fax:209-571-9052
Is Sole Proprietor?:No
Enumeration Date:2011-10-18
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57159183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist