Provider Demographics
NPI:1811695109
Name:PHUONG, MADISON (PHARMD)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:PHUONG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6275 BOULDER HWY APT 2002
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89122-7693
Mailing Address - Country:US
Mailing Address - Phone:951-532-2158
Mailing Address - Fax:
Practice Address - Street 1:8491 FARM RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89131-8241
Practice Address - Country:US
Practice Address - Phone:702-396-1713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV23391183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist