Healthcare Provider Details

I. General information

NPI: 1174921225
Provider Name (Legal Business Name): SY DUONG PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2014
Last Update Date: 12/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6901 SAN PEDRO AVE
SAN ANTONIO TX
78216-6206
US

IV. Provider business mailing address

6901 SAN PEDRO AVE
SAN ANTONIO TX
78216-6206
US

V. Phone/Fax

Practice location:
  • Phone: 210-349-9809
  • Fax: 210-349-5008
Mailing address:
  • Phone: 210-349-9809
  • Fax: 210-349-5008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number51717
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: