Provider Demographics
NPI:1407239544
Name:LUONG, MINH QUANG (PHARMD)
Entity Type:Individual
Prefix:
First Name:MINH
Middle Name:QUANG
Last Name:LUONG
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 1:14883 VAN BUREN ST
Mailing Address - Street 2:
Mailing Address - City:MIDWAY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92655-1268
Mailing Address - Country:US
Mailing Address - Phone:714-603-4166
Mailing Address - Fax:
Practice Address - Street 1:14883 VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:MIDWAY CITY
Practice Address - State:CA
Practice Address - Zip Code:92655-1268
Practice Address - Country:US
Practice Address - Phone:714-603-4166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA72727183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist