Provider Demographics
NPI:1467933150
Name:LUONG, NGOC QUYEN THI (PHARMD)
Entity Type:Individual
Prefix:
First Name:NGOC QUYEN
Middle Name:THI
Last Name:LUONG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 E CAPITOL EXPY SPC 17
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95121-1811
Mailing Address - Country:US
Mailing Address - Phone:408-667-7260
Mailing Address - Fax:
Practice Address - Street 1:30600 DYER ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-1717
Practice Address - Country:US
Practice Address - Phone:408-667-7260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA779531835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care