Provider Demographics
NPI:1336770338
Name:TRUONG, QUAN THE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:QUAN
Middle Name:THE
Last Name:TRUONG
Suffix:
Gender:M
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:PO BOX 384
Mailing Address - Street 2:
Mailing Address - City:CHINLE
Mailing Address - State:AZ
Mailing Address - Zip Code:86503-0384
Mailing Address - Country:US
Mailing Address - Phone:253-359-5243
Mailing Address - Fax:
Practice Address - Street 1:US HWAY 191 & HOSPITAL ROAD
Practice Address - Street 2:PO DRAWER PH
Practice Address - City:CHINLE
Practice Address - State:AZ
Practice Address - Zip Code:86503
Practice Address - Country:US
Practice Address - Phone:928-674-7001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI4413183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI4413OtherHAWAII STATE BOARD OF PHARMACY
1113676OtherNATIONAL ASSOCIATION OF BOARDS OF PHARMACY (NABP)
OK18428OtherOKLAHOMA STATE BOARD OF PHARMACY
WAPH60943871OtherWASHINGTON PHARMACY QUALITY ASSURANCE COMMISSION