Provider Demographics
NPI:1083229132
Name:DUONG, CHUONG (PHARMD)
Entity Type:Individual
Prefix:
First Name:CHUONG
Middle Name:
Last Name:DUONG
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 1:3644 CORVINA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-6950
Mailing Address - Country:US
Mailing Address - Phone:408-707-7518
Mailing Address - Fax:
Practice Address - Street 1:1250 E GIBSON RD
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95776-6315
Practice Address - Country:US
Practice Address - Phone:530-665-4309
Practice Address - Fax:530-665-4310
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82622183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist