Basic Information
| Provider Information | |||||||||
| NPI: | 1194058420 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DUONG | ||||||||
| FirstName: | THI | ||||||||
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| Credential: | PHARM.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 351 JOLLY JANUARY AVE | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891833542 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4806780377 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4700 LAS VEGAS BLVD NORTH | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891916601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7026533212 | ||||||||
| FaxNumber: | 7026532106 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2009 | ||||||||
| LastUpdateDate: | 09/18/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1835G0303X | 16737 | NV | Y | Pharmacy Service Providers | Pharmacist | Geriatric |
No ID Information.