MEDICARE: CO MAI DUONG RPH

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	87195	CA

General Provider Information

NPI Number	:	1215647490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CO MAI DUONG RPH

Provider Business Mailing Address
First Line	:	5823 ZOLLER CT
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95757-8365
Country	:	US
Telephone Number	:	916-293-1530
Fax Number	:

Provider Business Practice Location Address
First Line	:	5823 ZOLLER CT
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95757-8365
Country	:	US
Telephone Number	:	916-293-1530
Fax Number	:

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

Provider Enumeration Date	:	11/29/2022
Last Update Date	:	11/29/2022

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Directions to “ CO MAI DUONG RPH” Practice Location

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