Provider Demographics
NPI:1578044129
Name:TRUONG, BICHVAN NGUYEN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BICHVAN
Middle Name:NGUYEN
Last Name:TRUONG
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 1:13556 RARITAN ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80234-1035
Mailing Address - Country:US
Mailing Address - Phone:720-232-6735
Mailing Address - Fax:
Practice Address - Street 1:13556 RARITAN ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80234-1035
Practice Address - Country:US
Practice Address - Phone:720-232-6735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17239183500000X
COPHA.0017239183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PHA.0017239OtherPHARMACIST LICENSE