Healthcare Provider Details

I. General information

NPI: 1093029357
Provider Name (Legal Business Name): BAOLONG QUAN TRUONG RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2010
Last Update Date: 07/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 DOUGLASSVILLE SHOPPING CTR
DOUGLASSVILLE PA
19518-1543
US

IV. Provider business mailing address

137 FAIR MEADOW DR
DOUGLASSVILLE PA
19518-1146
US

V. Phone/Fax

Practice location:
  • Phone: 610-385-6643
  • Fax:
Mailing address:
  • Phone: 215-882-3484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP442172
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: