Healthcare Provider Details

I. General information

NPI: 1982236303
Provider Name (Legal Business Name): CALVIN P TRUONG PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2020
Last Update Date: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 17TH ST
MODESTO CA
95354-1209
US

IV. Provider business mailing address

9977 CARICO WAY
ELK GROVE CA
95757-6376
US

V. Phone/Fax

Practice location:
  • Phone: 209-248-7700
  • Fax:
Mailing address:
  • Phone: 415-342-4769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number81311
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: