Healthcare Provider Details

I. General information

NPI: 1528975745
Provider Name (Legal Business Name): LILY PHUONG DUONG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8097 TIMBERWOOD LN
ORLANDO FL
32825-3647
US

IV. Provider business mailing address

9405 MAPLE HILL CT
ORLANDO FL
32832-5644
US

V. Phone/Fax

Practice location:
  • Phone: 407-756-4689
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number33315
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: