Healthcare Provider Details

I. General information

NPI: 1255924635
Provider Name (Legal Business Name): THUC HOANG TRUONG PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2021
Last Update Date: 02/16/2021
Certification Date: 02/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18001 BOTHELL EVERETT HWY STE 101
BOTHELL WA
98012-1660
US

IV. Provider business mailing address

18001 BOTHELL EVERETT HWY STE 101
BOTHELL WA
98012-1660
US

V. Phone/Fax

Practice location:
  • Phone: 425-402-6485
  • Fax: 425-486-0106
Mailing address:
  • Phone: 425-402-6485
  • Fax: 425-486-0106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberIR60794783
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: