MEDICARE: QUANG BUU TRUONG

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	S013954	AZ

General Provider Information

NPI Number	:	1871802868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	QUANG BUU TRUONG

Provider Business Mailing Address
First Line	:	PO BOX 264
Second Line	:
City	:	AVONDALE
State	:	AZ
Zip	:	85323-0090
Country	:	US
Telephone Number	:	623-328-8148
Fax Number	:	623-934-3692

Provider Business Practice Location Address
First Line	:	6710 W BETHANY HOME RD
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85303-4402
Country	:	US
Telephone Number	:	623-934-9243
Fax Number	:	623-934-3692

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

Provider Enumeration Date	:	09/24/2010
Last Update Date	:	09/24/2010

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Directions to “ QUANG BUU TRUONG ” Practice Location

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