MEDICARE: MARY DUONG

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	46954	CA

General Provider Information

NPI Number	:	1942673876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY DUONG

Provider Business Mailing Address
First Line	:	16961 BEACH BLVD
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-4808
Country	:	US
Telephone Number	:	714-841-3591
Fax Number	:	714-848-0896

Provider Business Practice Location Address
First Line	:	16961 BEACH BLVD
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-4808
Country	:	US
Telephone Number	:	714-841-3591
Fax Number	:	714-848-0896

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

Provider Enumeration Date	:	10/30/2015
Last Update Date	:	10/30/2015

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Directions to “ MARY DUONG ” Practice Location

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