MEDICARE: MR. THONG BA TRUONG 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	PS35334	FL

General Provider Information

NPI Number	:	1669742169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THONG BA TRUONG RPH

Provider Business Mailing Address
First Line	:	3917 N NEBRASKA AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33603-5017
Country	:	US
Telephone Number	:	813-241-9885
Fax Number	:	813-247-9771

Provider Business Practice Location Address
First Line	:	3917 N NEBRASKA AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33603-5017
Country	:	US
Telephone Number	:	813-241-9885
Fax Number	:	813-247-9771

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

Provider Enumeration Date	:	12/31/2011
Last Update Date	:	12/31/2011

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