Provider Demographics
NPI:1437750064
Name:TU, CUONG TUNG (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CUONG
Middle Name:TUNG
Last Name:TU
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 1:3209 DEANS BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30906-4201
Mailing Address - Country:US
Mailing Address - Phone:706-796-7754
Mailing Address - Fax:706-796-7818
Practice Address - Street 1:3209 DEANS BRIDGE RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30906-4201
Practice Address - Country:US
Practice Address - Phone:706-796-7754
Practice Address - Fax:706-796-7818
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH027551183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist