Provider Demographics
NPI:1881299493
Name:TRUONG, MICHELLE MAI TUYET (REGISTER PHARMACIST)
Entity type:Individual
Prefix:
First Name:MICHELLE MAI
Middle Name:TUYET
Last Name:TRUONG
Suffix:
Gender:F
Credentials:REGISTER PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1372 BELT LINE RD
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-3266
Mailing Address - Country:US
Mailing Address - Phone:972-495-1933
Mailing Address - Fax:972-495-6194
Practice Address - Street 1:1372 BELT LINE RD
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-3266
Practice Address - Country:US
Practice Address - Phone:972-495-1933
Practice Address - Fax:972-495-6194
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36371183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist