Healthcare Provider Details

I. General information

NPI: 1548972011
Provider Name (Legal Business Name): ELIZABETH TO TIEN VUONG PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2022
Last Update Date: 12/15/2022
Certification Date: 12/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3809 E WATKINS ST
PHOENIX AZ
85034-7264
US

IV. Provider business mailing address

2345 E SMOKE TREE RD
GILBERT AZ
85296-2717
US

V. Phone/Fax

Practice location:
  • Phone: 855-745-5725
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS026214
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: