Healthcare Provider Details

I. General information

NPI: 1740018381
Provider Name (Legal Business Name): SANDRA R DUONG PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2024
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7411 NE 117TH AVE
VANCOUVER WA
98662-4706
US

IV. Provider business mailing address

3800 SE 22ND AVE MAILSTOP: 04002/34K
PORTLAND OR
97202-2999
US

V. Phone/Fax

Practice location:
  • Phone: 360-896-3533
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH-0020350
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPHRM.PH.61571901
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: