Provider Demographics
NPI:1497219638
Name:LUONG, QUOC (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:QUOC
Middle Name:
Last Name:LUONG
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 1:1205 E VIA ROMA DR
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93730-8800
Mailing Address - Country:US
Mailing Address - Phone:559-916-4854
Mailing Address - Fax:
Practice Address - Street 1:3044 TULARE ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-1473
Practice Address - Country:US
Practice Address - Phone:559-266-0701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-22
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65421183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2217241Medicaid