Healthcare Provider Details

I. General information

NPI: 1710587373
Provider Name (Legal Business Name): AN NHAN LE VUONG PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2020
Last Update Date: 10/31/2020
Certification Date: 10/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1770 S ELM PL
BROKEN ARROW OK
74012-6453
US

IV. Provider business mailing address

500 E FREDERICKSBURG ST
BROKEN ARROW OK
74011-3590
US

V. Phone/Fax

Practice location:
  • Phone: 918-258-6185
  • Fax: 918-258-6188
Mailing address:
  • Phone: 918-814-4181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14537
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: