Healthcare Provider Details

I. General information

NPI: 1649271982
Provider Name (Legal Business Name): MINH-TRI L DUONG PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 COLUMBIA DR
TAMPA FL
33606-3508
US

IV. Provider business mailing address

2925 W KNIGHTS AVE
TAMPA FL
33611-1621
US

V. Phone/Fax

Practice location:
  • Phone: 813-844-4473
  • Fax: 813-844-4062
Mailing address:
  • Phone: 813-844-4735
  • Fax: 813-844-4062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberPS-32577
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: