Provider Demographics
NPI:1255685095
Name:VO, CONG-THIEN QUOC (RPH)
Entity Type:Individual
Prefix:
First Name:CONG-THIEN
Middle Name:QUOC
Last Name:VO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17404 MERIDIAN E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-6234
Mailing Address - Country:US
Mailing Address - Phone:253-445-7873
Mailing Address - Fax:253-445-7867
Practice Address - Street 1:17404 MERIDIAN E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-6234
Practice Address - Country:US
Practice Address - Phone:253-445-7873
Practice Address - Fax:253-445-7867
Is Sole Proprietor?:No
Enumeration Date:2012-11-01
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60294287183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist