Healthcare Provider Details

I. General information

NPI: 1881925386
Provider Name (Legal Business Name): DAVID MINH VUONG PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2010
Last Update Date: 12/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BODIN CIRCLE PHARMACY
TRAVIS AFB CA
94535
US

IV. Provider business mailing address

6801 LEISURE TOWN RD APT 12
VACAVILLE CA
95688-9432
US

V. Phone/Fax

Practice location:
  • Phone: 707-423-7656
  • Fax:
Mailing address:
  • Phone: 215-939-3404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number20799
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP444378
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: