Provider Demographics
NPI:1235690041
Name:HUA, DELIA LUONG (PHARM D)
Entity Type:Individual
Prefix:
First Name:DELIA
Middle Name:LUONG
Last Name:HUA
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:551 MIDWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-4828
Mailing Address - Country:US
Mailing Address - Phone:408-910-1200
Mailing Address - Fax:
Practice Address - Street 1:442 LAS GALLINAS AVE
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-3618
Practice Address - Country:US
Practice Address - Phone:415-479-9171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-26
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA76639183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist