Healthcare Provider Details

I. General information

NPI: 1710589973
Provider Name (Legal Business Name): LAWRENCE VUONG PHARM D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2020
Last Update Date: 11/12/2020
Certification Date: 11/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 S GARLAND AVE
GARLAND TX
75040-7648
US

IV. Provider business mailing address

6361 NAAMAN FOREST BLVD APT 12312
GARLAND TX
75044-5746
US

V. Phone/Fax

Practice location:
  • Phone: 972-535-1429
  • Fax:
Mailing address:
  • Phone: 817-903-3199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number49669
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: