Provider Demographics
NPI:1952774325
Name:TRUONG, ANHDAO (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANHDAO
Middle Name:
Last Name:TRUONG
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 1:13872 HARBOR BLVD #1A
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-4000
Mailing Address - Country:US
Mailing Address - Phone:714-554-4754
Mailing Address - Fax:714-554-6052
Practice Address - Street 1:13872 HARBOR BLVD #1A
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-4000
Practice Address - Country:US
Practice Address - Phone:714-554-4754
Practice Address - Fax:714-554-6052
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-07
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54941183500000X
CAPHY53866183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist