Provider Demographics
NPI:1134427743
Name:TRINH, ALICE DUONG
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:DUONG
Last Name:TRINH
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:ALICE
Other - Middle Name:DUONG
Other - Last Name:TRINH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:2615 WOODSTOCK LN
Mailing Address - Street 2:2615 WOODSTOCK LANE
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91504-1839
Mailing Address - Country:US
Mailing Address - Phone:818-720-5054
Mailing Address - Fax:
Practice Address - Street 1:2615 WOODSTOCK LN
Practice Address - Street 2:2615 WOODSTOCK LANE
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91504-1839
Practice Address - Country:US
Practice Address - Phone:818-720-5054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-05
Last Update Date:2011-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62656183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist