Healthcare Provider Details

I. General information

NPI: 1689825242
Provider Name (Legal Business Name): TUYET JENNIFER VUONG PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2008
Last Update Date: 10/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 MUIR RD
MARTINEZ CA
94553-4668
US

IV. Provider business mailing address

3108 AVONMORE DR
MODESTO CA
95355-8675
US

V. Phone/Fax

Practice location:
  • Phone: 925-372-2380
  • Fax:
Mailing address:
  • Phone: 209-551-6983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14560
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number041947-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: