Provider Demographics
NPI:1174995385
Name:ONG, HA QUYEN THI (PHARMD)
Entity type:Individual
Prefix:
First Name:HA QUYEN
Middle Name:THI
Last Name:ONG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:QUYEN
Other - Middle Name:THI
Other - Last Name:BUI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1357 EARLY BLUE LN
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-2018
Mailing Address - Country:US
Mailing Address - Phone:714-467-6563
Mailing Address - Fax:
Practice Address - Street 1:600 N HIGHLAND SPRINGS AVE
Practice Address - Street 2:
Practice Address - City:BANNING
Practice Address - State:CA
Practice Address - Zip Code:92220-3046
Practice Address - Country:US
Practice Address - Phone:951-769-4888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-27
Last Update Date:2020-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA69850183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist