Healthcare Provider Details

I. General information

NPI: 1538341466
Provider Name (Legal Business Name): LINDA HUONG QUANG PHARM.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2007
Last Update Date: 12/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 BICENTENNIAL WAY STE 315 ANTICOAGULATION CLINIC
SANTA ROSA CA
95403-2149
US

IV. Provider business mailing address

PO BOX 545
PENNGROVE CA
94951-0545
US

V. Phone/Fax

Practice location:
  • Phone: 707-571-3287
  • Fax: 707-571-4815
Mailing address:
  • Phone: 707-338-9779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number47184
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: