Healthcare Provider Details

I. General information

NPI: 1801496393
Provider Name (Legal Business Name): MONA VUONG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2020
Last Update Date: 10/26/2020
Certification Date: 10/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5680 HAMMONDS MILL RD
MARTINSBURG WV
25404-6421
US

IV. Provider business mailing address

5680 HAMMONDS MILL RD
MARTINSBURG WV
25404-6421
US

V. Phone/Fax

Practice location:
  • Phone: 304-274-3873
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP0009246
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: