Provider Demographics
NPI:1942772066
Name:LUONG, LANEY NICOLE (PHARM D)
Entity Type:Individual
Prefix:
First Name:LANEY
Middle Name:NICOLE
Last Name:LUONG
Suffix:
Gender:F
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 1:763 LAKEHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94089-2552
Mailing Address - Country:US
Mailing Address - Phone:408-728-5075
Mailing Address - Fax:
Practice Address - Street 1:260 INTERNATIONAL CIRCLE
Practice Address - Street 2:BUILDING 4 OUTPATIENT PHARMACY
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119-1130
Practice Address - Country:US
Practice Address - Phone:408-728-5075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-31
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79020183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist