Provider Demographics
NPI:1447588645
Name:VONG, JENNY (RPH)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:VONG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11675 W AIRPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-3041
Mailing Address - Country:US
Mailing Address - Phone:281-313-6403
Mailing Address - Fax:281-313-6407
Practice Address - Street 1:11675 W AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-3041
Practice Address - Country:US
Practice Address - Phone:281-313-6403
Practice Address - Fax:281-313-6407
Is Sole Proprietor?:No
Enumeration Date:2009-11-27
Last Update Date:2009-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35965183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist