Provider Demographics
NPI:1639491251
Name:DUONG, MAI (PHARMACIST)
Entity Type:Individual
Prefix:MS
First Name:MAI
Middle Name:
Last Name:DUONG
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3418 202ND ST
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-1146
Mailing Address - Country:US
Mailing Address - Phone:718-229-2549
Mailing Address - Fax:
Practice Address - Street 1:3418 202ND ST
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-1146
Practice Address - Country:US
Practice Address - Phone:718-229-2549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20041535183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist