Provider Demographics
NPI:1346876760
Name:LUONG, VINCENT (RPH)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:
Last Name:LUONG
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 1:9652 WOODBURY AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-2816
Mailing Address - Country:US
Mailing Address - Phone:714-949-7868
Mailing Address - Fax:
Practice Address - Street 1:13763 MONO WAY
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-8813
Practice Address - Country:US
Practice Address - Phone:209-532-6973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-17
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82179183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist