Provider Demographics
NPI:1598974735
Name:VU, TUNG T (BSPHARM)
Entity Type:Individual
Prefix:
First Name:TUNG
Middle Name:T
Last Name:VU
Suffix:
Gender:M
Credentials:BSPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9100 S TRYON ST STE A
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-3113
Mailing Address - Country:US
Mailing Address - Phone:704-588-9623
Mailing Address - Fax:704-588-9624
Practice Address - Street 1:9100-A SOUTH TRYON ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273
Practice Address - Country:US
Practice Address - Phone:704-588-9623
Practice Address - Fax:704-588-9624
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15921183500000X
SC10282183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC15921OtherNC PHARMACIST LICENSE
SC10282OtherSC PHARMACIST LICENSE