Healthcare Provider Details

I. General information

NPI: 1124885363
Provider Name (Legal Business Name): MARRY TRAN VUONG PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARRY TRAN VUONG PHARMD

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18036 SW 145TH AVE
MIAMI FL
33177-3330
US

IV. Provider business mailing address

18036 SW 145TH AVE
MIAMI FL
33177-3330
US

V. Phone/Fax

Practice location:
  • Phone: 305-972-3251
  • Fax:
Mailing address:
  • Phone: 305-972-3251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0200X
TaxonomyPediatric Pharmacist
License NumberPS57812
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: