Provider Demographics
NPI:1790380962
Name:PHUNG, LINH GIA (PHARMD)
Entity Type:Individual
Prefix:
First Name:LINH
Middle Name:GIA
Last Name:PHUNG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22409 BLOSSOM DR
Mailing Address - Street 2:
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-2023
Mailing Address - Country:US
Mailing Address - Phone:440-454-5767
Mailing Address - Fax:
Practice Address - Street 1:17400 LORAIN AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-4028
Practice Address - Country:US
Practice Address - Phone:216-252-4747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03237457183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist