MEDICARE: LONG MINH VU PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	71314	TX

General Provider Information

NPI Number	:	1366164840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LONG MINH VU PHARMD

Provider Business Mailing Address
First Line	:	108 NE 28TH ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76164-7203
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	108 NE 28TH ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76164-7203
Country	:	US
Telephone Number	:	817-378-0527
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2022
Last Update Date	:	09/13/2022

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