Healthcare Provider Details

I. General information

NPI: 1730848664
Provider Name (Legal Business Name): AMY DUONG PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2021
Last Update Date: 07/02/2024
Certification Date: 07/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 PARK ST
NEW HAVEN CT
06511-5474
US

IV. Provider business mailing address

5826 UNION GROVE DR
BRASELTON GA
30517-5111
US

V. Phone/Fax

Practice location:
  • Phone: 203-688-4242
  • Fax:
Mailing address:
  • Phone: 262-374-3937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberPCT.0016634
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number033704
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number068607
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: