Healthcare Provider Details

I. General information

NPI: 1497219638
Provider Name (Legal Business Name): QUOC LUONG PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2019
Last Update Date: 11/09/2022
Certification Date: 04/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3044 TULARE ST
FRESNO CA
93721-1473
US

IV. Provider business mailing address

1205 E VIA ROMA DR
FRESNO CA
93730-8800
US

V. Phone/Fax

Practice location:
  • Phone: 559-266-0701
  • Fax:
Mailing address:
  • Phone: 559-916-4854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number65421
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: