Provider Demographics
NPI:1952691123
Name:DANG, QUINN MONG (RPH)
Entity Type:Individual
Prefix:MS
First Name:QUINN
Middle Name:MONG
Last Name:DANG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9959 E HILL DR
Mailing Address - Street 2:
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-2431
Mailing Address - Country:US
Mailing Address - Phone:214-923-3061
Mailing Address - Fax:
Practice Address - Street 1:1003 W BROAD ST
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-4610
Practice Address - Country:US
Practice Address - Phone:703-241-5031
Practice Address - Fax:703-241-5037
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-08
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02022096271835P2201X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX37232OtherSTATE PHARMACIST LICENSE