Provider Demographics
NPI:1063012698
Name:VO, MY DUNG THI (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MY DUNG
Middle Name:THI
Last Name:VO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13122 PEACH LEAF PL
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-8217
Mailing Address - Country:US
Mailing Address - Phone:703-889-7313
Mailing Address - Fax:
Practice Address - Street 1:801 JAMES MADISON HWY
Practice Address - Street 2:
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-2405
Practice Address - Country:US
Practice Address - Phone:540-825-4114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-01
Last Update Date:2021-05-18
Deactivation Date:2021-04-26
Deactivation Code:
Reactivation Date:2021-05-18
Provider Licenses
StateLicense IDTaxonomies
VA0202213187183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist