MEDICARE: THANHMAI LUONG 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	PS35059	FL

General Provider Information

NPI Number	:	1447529714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THANHMAI LUONG PHARMD

Provider Business Mailing Address
First Line	:	5601 N HIAWASSEE RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32818-1368
Country	:	US
Telephone Number	:	407-293-7754
Fax Number	:	407-293-7312

Provider Business Practice Location Address
First Line	:	5601 N HIAWASSEE RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32818-1368
Country	:	US
Telephone Number	:	407-293-7754
Fax Number	:	407-293-7312

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

Provider Enumeration Date	:	12/15/2011
Last Update Date	:	12/15/2011

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Directions to “ THANHMAI LUONG PHARMD” Practice Location

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