Healthcare Provider Details

I. General information

NPI: 1427537638
Provider Name (Legal Business Name): HOLLY VUONG PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2018
Last Update Date: 08/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15700 METCALF AVE
OVERLAND PARK KS
66223-3004
US

IV. Provider business mailing address

10532 WALMER ST
OVERLAND PARK KS
66212-1885
US

V. Phone/Fax

Practice location:
  • Phone: 913-685-7493
  • Fax:
Mailing address:
  • Phone: 913-244-8137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number113062
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: