Provider Demographics
NPI:1689940199
Name:TRUONG, CUONG MINH (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:CUONG
Middle Name:MINH
Last Name:TRUONG
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7250 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98408
Mailing Address - Country:US
Mailing Address - Phone:253-475-1994
Mailing Address - Fax:253-475-6082
Practice Address - Street 1:7250 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98408
Practice Address - Country:US
Practice Address - Phone:253-475-1994
Practice Address - Fax:253-475-6082
Is Sole Proprietor?:No
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH 00069677183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist