Provider Demographics
NPI:1467721621
Name:CHUONG, QUYEN PHAM (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:QUYEN
Middle Name:PHAM
Last Name:CHUONG
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12550 HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:GRAND BAY
Mailing Address - State:AL
Mailing Address - Zip Code:36541-5609
Mailing Address - Country:US
Mailing Address - Phone:251-865-1429
Mailing Address - Fax:251-865-1478
Practice Address - Street 1:12550 HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:GRAND BAY
Practice Address - State:AL
Practice Address - Zip Code:36541-5609
Practice Address - Country:US
Practice Address - Phone:251-865-1429
Practice Address - Fax:251-865-1478
Is Sole Proprietor?:No
Enumeration Date:2011-12-17
Last Update Date:2011-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16567183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist