Provider Demographics
NPI:1417414798
Name:DUONG, XUAN T (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:XUAN
Middle Name:T
Last Name:DUONG
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12387 YELLOW BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32226-2025
Mailing Address - Country:US
Mailing Address - Phone:904-751-2744
Mailing Address - Fax:
Practice Address - Street 1:12387 YELLOW BLUFF RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32226-2025
Practice Address - Country:US
Practice Address - Phone:904-751-2744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-22
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80286183500000X
FLPS63606183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist