MEDICARE: AN CUONG LLC

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	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457428757
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AN CUONG LLC

Provider Business Mailing Address
First Line	:	PO BOX 29636
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70189-0636
Country	:	US
Telephone Number	:	504-254-9034
Fax Number	:	504-254-5028

Provider Business Practice Location Address
First Line	:	4623 ALCEE FORTIER BLVD
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70129-2140
Country	:	US
Telephone Number	:	504-254-9034
Fax Number	:	504-254-5028

Authorized Official
Title or Position	:	PHARMACIST
Name	:	MRS. AN N TRAN
Credential	:	RPH
Telephone Number	:	504-254-9034

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	03/04/2009

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Directions to “AN CUONG LLC ” Practice Location

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