Provider Demographics
NPI:1740027887
Name:DO, TRA BUI HUONG N/A (PHARMD)
Entity type:Individual
Prefix:
First Name:TRA BUI HUONG
Middle Name:N/A
Last Name:DO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:TRA BUI HUONG
Other - Middle Name:
Other - Last Name:DO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:16995 LAKE KNOLL PKWY
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-6561
Mailing Address - Country:US
Mailing Address - Phone:909-573-2835
Mailing Address - Fax:
Practice Address - Street 1:16995 LAKE KNOLL PKWY
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-6561
Practice Address - Country:US
Practice Address - Phone:909-573-2835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88458183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist