Provider Demographics
NPI:1700305836
Name:BUI, EDMUND TRUNG (RPH)
Entity Type:Individual
Prefix:
First Name:EDMUND
Middle Name:TRUNG
Last Name:BUI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3405 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-1402
Mailing Address - Country:US
Mailing Address - Phone:419-381-5009
Mailing Address - Fax:419-381-5006
Practice Address - Street 1:2127 AUDUBON PL
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3301
Practice Address - Country:US
Practice Address - Phone:419-343-2920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-09
Last Update Date:2017-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03323904183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist