Provider Demographics
NPI:1821304361
Name:BUITRAN, VANHONG (PHARMACIST)
Entity Type:Individual
Prefix:DR
First Name:VANHONG
Middle Name:
Last Name:BUITRAN
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:DR
Other - First Name:VANHONG
Other - Middle Name:
Other - Last Name:BUITRAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:PO BOX 393
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92871-0393
Mailing Address - Country:US
Mailing Address - Phone:909-593-2619
Mailing Address - Fax:
Practice Address - Street 1:1479 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-3451
Practice Address - Country:US
Practice Address - Phone:909-593-2619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-22
Last Update Date:2010-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52036183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist