Provider Demographics
NPI:1245557057
Name:DUONG, CINDY THANH (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:THANH
Last Name:DUONG
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CONNOLLY ST
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-1508
Mailing Address - Country:US
Mailing Address - Phone:781-963-2904
Mailing Address - Fax:617-328-6004
Practice Address - Street 1:475 HANCOCK ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02171-2414
Practice Address - Country:US
Practice Address - Phone:617-328-6004
Practice Address - Fax:617-328-1893
Is Sole Proprietor?:No
Enumeration Date:2010-05-03
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH25842183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist