Provider Demographics
NPI:1346918570
Name:DUONG, THANH BA (RPH)
Entity Type:Individual
Prefix:
First Name:THANH
Middle Name:BA
Last Name:DUONG
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 1:8482 BLUE MAIDEN WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-3896
Mailing Address - Country:US
Mailing Address - Phone:916-834-5933
Mailing Address - Fax:
Practice Address - Street 1:14115 LAKERIDGE CIR
Practice Address - Street 2:
Practice Address - City:MAGALIA
Practice Address - State:CA
Practice Address - Zip Code:95954-9470
Practice Address - Country:US
Practice Address - Phone:530-873-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84820183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist