Provider Demographics
NPI:1275022154
Name:DO, DENNIS TRUNG (PHARMD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:TRUNG
Last Name:DO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9333 GLENDON WAY
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-2006
Mailing Address - Country:US
Mailing Address - Phone:626-688-7098
Mailing Address - Fax:
Practice Address - Street 1:3250 BIG DALTON AVE
Practice Address - Street 2:
Practice Address - City:BALDWIN PARK
Practice Address - State:CA
Practice Address - Zip Code:91706-5107
Practice Address - Country:US
Practice Address - Phone:626-814-4790
Practice Address - Fax:626-814-9899
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-06
Last Update Date:2018-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64474183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty