Provider Demographics
NPI:1073113528
Name:VONG, VITOU
Entity Type:Individual
Prefix:
First Name:VITOU
Middle Name:
Last Name:VONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 W COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76801-1701
Mailing Address - Country:US
Mailing Address - Phone:325-643-2029
Mailing Address - Fax:325-646-9314
Practice Address - Street 1:401 W COMMERCE ST
Practice Address - Street 2:
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-1701
Practice Address - Country:US
Practice Address - Phone:325-643-2029
Practice Address - Fax:325-646-9314
Is Sole Proprietor?:No
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65113183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist