MEDICARE: DR. AMY PHUONG VU PHARMD

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	0202204858	VA

General Provider Information

NPI Number	:	1801491212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMY PHUONG VU PHARMD

Provider Business Mailing Address
First Line	:	4979 COLLIN CHASE PL
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22030-8282
Country	:	US
Telephone Number	:	571-228-9387
Fax Number	:

Provider Business Practice Location Address
First Line	:	264 CEDAR LN SE
Second Line	:
City	:	VIENNA
State	:	VA
Zip	:	22180-6613
Country	:	US
Telephone Number	:	703-876-0388
Fax Number	:	703-876-1842

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

Provider Enumeration Date	:	12/02/2020
Last Update Date	:	12/02/2020

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