Provider Demographics
NPI:1598013559
Name:LA, DUNG TRINA (PHARMD)
Entity Type:Individual
Prefix:
First Name:DUNG
Middle Name:TRINA
Last Name:LA
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 1:230 W CATALPA DR
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-8321
Mailing Address - Country:US
Mailing Address - Phone:574-256-2630
Mailing Address - Fax:574-256-2669
Practice Address - Street 1:230 W CATALPA DR
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-8321
Practice Address - Country:US
Practice Address - Phone:574-256-2630
Practice Address - Fax:574-256-2669
Is Sole Proprietor?:No
Enumeration Date:2012-08-24
Last Update Date:2012-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26024669A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist