Provider Demographics
NPI:1326320466
Name:TRUONG, ROSE T (BS)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:T
Last Name:TRUONG
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 POINT LOBOS AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121-1530
Mailing Address - Country:US
Mailing Address - Phone:415-386-0736
Mailing Address - Fax:415-386-3005
Practice Address - Street 1:25 POINT LOBOS AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94121-1530
Practice Address - Country:US
Practice Address - Phone:415-386-0736
Practice Address - Fax:415-386-3005
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45007183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist