Provider Demographics
NPI:1942691415
Name:TRUONG, GAI (PHARMD)
Entity Type:Individual
Prefix:
First Name:GAI
Middle Name:
Last Name:TRUONG
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 1:1720A MEDICAL PARK DR
Mailing Address - Street 2:SUITE 160
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-2129
Mailing Address - Country:US
Mailing Address - Phone:228-207-7716
Mailing Address - Fax:228-207-9598
Practice Address - Street 1:1720A MEDICAL PARK DR
Practice Address - Street 2:SUITE 160
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-2129
Practice Address - Country:US
Practice Address - Phone:228-207-7716
Practice Address - Fax:228-207-9598
Is Sole Proprietor?:No
Enumeration Date:2015-02-05
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSP09598183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06972060Medicaid
MS06972060Medicaid