Healthcare Provider Details

I. General information

NPI: 1063747525
Provider Name (Legal Business Name): CUONG DUONG DOCTOR OF PHARMACY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2009
Last Update Date: 03/07/2023
Certification Date: 12/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 TAMARACK AVE
CARLSBAD CA
92008-3414
US

IV. Provider business mailing address

PO BOX 130803
CARLSBAD CA
92013-0803
US

V. Phone/Fax

Practice location:
  • Phone: 760-729-4877
  • Fax:
Mailing address:
  • Phone: 760-994-0900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number62377
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: