Provider Demographics
NPI:1114259322
Name:TRUONG, CHARLES (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:TRUONG
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 OSPREY DR
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-2053
Mailing Address - Country:US
Mailing Address - Phone:718-938-0530
Mailing Address - Fax:
Practice Address - Street 1:34 OSPREY DR
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-2053
Practice Address - Country:US
Practice Address - Phone:718-938-0530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-12
Last Update Date:2014-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02547500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist