Healthcare Provider Details

I. General information

NPI: 1548509714
Provider Name (Legal Business Name): DAT VUONG PHARM. D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2013
Last Update Date: 02/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 S TAMIAMI TRL
SARASOTA FL
34239-2207
US

IV. Provider business mailing address

7467 ROXYE LN
SARASOTA FL
34240-7815
US

V. Phone/Fax

Practice location:
  • Phone: 941-953-9804
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS49603
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: