Provider Demographics
NPI:1447583968
Name:TRUONG, PHILLIP M (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:M
Last Name:TRUONG
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 1:5040 BEATTIES FORD RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-2835
Mailing Address - Country:US
Mailing Address - Phone:704-394-1714
Mailing Address - Fax:704-394-8743
Practice Address - Street 1:5040 BEATTIES FORD RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-2835
Practice Address - Country:US
Practice Address - Phone:704-394-1714
Practice Address - Fax:704-394-8743
Is Sole Proprietor?:No
Enumeration Date:2009-09-15
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18073183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist