Healthcare Provider Details

I. General information

NPI: 1710003819
Provider Name (Legal Business Name): HUE NGOC VUONG PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2130 WEALTHY ST SE
GRAND RAPIDS MI
49506-3032
US

IV. Provider business mailing address

5503 W HEATHWOOD DR SE
KENTWOOD MI
49512-9516
US

V. Phone/Fax

Practice location:
  • Phone: 616-451-0711
  • Fax: 616-454-4213
Mailing address:
  • Phone: 616-656-9073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302033587
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: