Healthcare Provider Details

I. General information

NPI: 1114336971
Provider Name (Legal Business Name): STEVEN VUONG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2014
Last Update Date: 08/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 N MAIN ST
EL DORADO KS
67042-4526
US

IV. Provider business mailing address

700 N MAIN ST
EL DORADO KS
67042-4526
US

V. Phone/Fax

Practice location:
  • Phone: 316-321-0318
  • Fax: 316-321-8810
Mailing address:
  • Phone: 316-321-0318
  • Fax: 316-321-8810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1-12963
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: