Provider Demographics
NPI:1649588187
Name:TRUONG, PAMELA PHUONG (RPH)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:PHUONG
Last Name:TRUONG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9087 BLUE JUG LNDG
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-2106
Mailing Address - Country:US
Mailing Address - Phone:703-425-2402
Mailing Address - Fax:
Practice Address - Street 1:6053 LEESBURG PIKE
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22041-2205
Practice Address - Country:US
Practice Address - Phone:703-845-3771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-17
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202010785183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist