MEDICARE: QUYNHANH PHUNG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS45501	FL

General Provider Information

NPI Number	:	1114296407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	QUYNHANH PHUNG

Provider Business Mailing Address
First Line	:	14853 58TH ST N
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33760-2342
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10196 66TH ST N
Second Line	:
City	:	PINELLAS PARK
State	:	FL
Zip	:	33782-3015
Country	:	US
Telephone Number	:	727-545-2420
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2011
Last Update Date	:	12/15/2011

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Directions to “ QUYNHANH PHUNG ” Practice Location

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