Provider Demographics
NPI:1053619015
Name:TRUONG, MICHAEL HUU (RPH)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:HUU
Last Name:TRUONG
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:677 N DUPONT BLVD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963-1001
Mailing Address - Country:US
Mailing Address - Phone:302-422-3341
Mailing Address - Fax:302-422-8575
Practice Address - Street 1:677 N DUPONT BLVD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-1001
Practice Address - Country:US
Practice Address - Phone:302-422-3341
Practice Address - Fax:302-422-8575
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-28
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0003247183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist