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General NPI Number Information
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NPI Number | 1003778739
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Entity Type | Individual
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Provider Name | KRISTINA TRUONG
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Gender | Female
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Dates
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Enumeration Date | 12/01/2025
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 1350 S ROUTE 12
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City | FOX LAKE
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State | IL
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Zip | 60020-1930
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Country | US
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Telephone | 847-973-9075
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Fax |
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Provider Business Mailing Address
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Address Line | 977 FORESTVIEW WAY
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City | ANTIOCH
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State | IL
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Zip | 60002-6217
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 051307355
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License Number State | IL
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