Provider Demographics
NPI:1114783669
Name:VANTRUONG, HANNAH (PHARMD)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:VANTRUONG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:HOANG
Other - Middle Name:TRUONG MY
Other - Last Name:VAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4603 MINNEHAHA AVE UNIT 317
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-4269
Mailing Address - Country:US
Mailing Address - Phone:515-770-9996
Mailing Address - Fax:
Practice Address - Street 1:1 VETERANS DR
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417-2309
Practice Address - Country:US
Practice Address - Phone:515-770-9996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA24772183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist