Provider Demographics
NPI:1720399959
Name:TRUONG, MYLIEN T
Entity Type:Individual
Prefix:
First Name:MYLIEN
Middle Name:T
Last Name:TRUONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5740 N GRAHAM ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-4839
Mailing Address - Country:US
Mailing Address - Phone:704-596-1034
Mailing Address - Fax:704-599-2940
Practice Address - Street 1:5740 N GRAHAM ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-4839
Practice Address - Country:US
Practice Address - Phone:704-596-1034
Practice Address - Fax:704-599-2940
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-22
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16940183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist