Provider Demographics
NPI:1437753563
Name:PHAN, DUC HUONG TRUNG
Entity Type:Individual
Prefix:MR
First Name:DUC
Middle Name:HUONG TRUNG
Last Name:PHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6042 SW HIGHWAY 200
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34476-5558
Mailing Address - Country:US
Mailing Address - Phone:352-873-0984
Mailing Address - Fax:352-854-2816
Practice Address - Street 1:6042 SW HIGHWAY 200
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34476-5558
Practice Address - Country:US
Practice Address - Phone:352-873-0984
Practice Address - Fax:352-854-2816
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS25980183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist