Healthcare Provider Details

I. General information

NPI: 1447520317
Provider Name (Legal Business Name): ANHTHU LUONG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2012
Last Update Date: 01/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8802 W COLONIAL DR
OCOEE FL
34761-6903
US

IV. Provider business mailing address

8802 W COLONIAL DR
OCOEE FL
34761-6903
US

V. Phone/Fax

Practice location:
  • Phone: 407-578-2283
  • Fax: 407-292-3720
Mailing address:
  • Phone: 407-578-2283
  • Fax: 407-292-3720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS35487
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: