Healthcare Provider Details

I. General information

NPI: 1942137310
Provider Name (Legal Business Name): MINH DONG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 SKYLINE DR
JACKSON TN
38301-3923
US

IV. Provider business mailing address

9 FAWNWOOD CV
JACKSON TN
38305-6463
US

V. Phone/Fax

Practice location:
  • Phone: 731-541-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: