Healthcare Provider Details

I. General information

NPI: 1508270083
Provider Name (Legal Business Name): JOE Y VUONG PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2014
Last Update Date: 06/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 E PINE ST .
LODI CA
93312
US

IV. Provider business mailing address

339 E PINE ST
LODI CA
95240-2937
US

V. Phone/Fax

Practice location:
  • Phone: 209-242-3838
  • Fax:
Mailing address:
  • Phone: 209-242-3838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number56971
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: