Provider Demographics
NPI:1912283094
Name:TRINH, PHUONG (PHARMD)
Entity Type:Individual
Prefix:
First Name:PHUONG
Middle Name:
Last Name:TRINH
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 1:10 SELENE PL
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-5457
Mailing Address - Country:US
Mailing Address - Phone:352-283-2597
Mailing Address - Fax:
Practice Address - Street 1:5000 E HIGHWAY 100
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-2363
Practice Address - Country:US
Practice Address - Phone:386-586-3830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS47969183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist