Provider Demographics
NPI:1093029357
Name:TRUONG, BAOLONG QUAN (RPH)
Entity Type:Individual
Prefix:DR
First Name:BAOLONG
Middle Name:QUAN
Last Name:TRUONG
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 FAIR MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:DOUGLASSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19518-1146
Mailing Address - Country:US
Mailing Address - Phone:215-882-3484
Mailing Address - Fax:
Practice Address - Street 1:12 DOUGLASSVILLE SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:DOUGLASSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19518-1543
Practice Address - Country:US
Practice Address - Phone:610-385-6643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-28
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP442172183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist