Basic Information
| Provider Information | |||||||||
| NPI: | 1336770338 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TRUONG | ||||||||
| FirstName: | QUAN | ||||||||
| MiddleName: | THE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 384 | ||||||||
| Address2: | |||||||||
| City: | CHINLE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 865030384 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2533595243 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | US HWAY 191 & HOSPITAL ROAD | ||||||||
| Address2: | PO DRAWER PH | ||||||||
| City: | CHINLE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 86503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9286747001 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2020 | ||||||||
| LastUpdateDate: | 01/29/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 4413 | HI | Y | Pharmacy Service Providers | Pharmacist |
ID Information
| ID | Type | State | Issuer | Description | 4413 | 01 | HI | HAWAII STATE BOARD OF PHARMACY | OTHER | 1113676 | 01 | NATIONAL ASSOCIATION OF BOARDS OF PHARMACY (NABP) | OTHER | 18428 | 01 | OK | OKLAHOMA STATE BOARD OF PHARMACY | OTHER | PH60943871 | 01 | WA | WASHINGTON PHARMACY QUALITY ASSURANCE COMMISSION | OTHER |