Provider Demographics
NPI:1417613696
Name:KY, TRUNG QUANG (PHARMD)
Entity Type:Individual
Prefix:
First Name:TRUNG
Middle Name:QUANG
Last Name:KY
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 1:4333 N 6TH DR APT 235
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-3193
Mailing Address - Country:US
Mailing Address - Phone:626-254-3964
Mailing Address - Fax:
Practice Address - Street 1:500 W THOMAS RD STE 300
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4294
Practice Address - Country:US
Practice Address - Phone:602-406-5081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-12
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS0255201835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist