Provider Demographics
NPI:1053998773
Name:LUONG, DAN (RPH, PHARMD, BS)
Entity type:Individual
Prefix:
First Name:DAN
Middle Name:
Last Name:LUONG
Suffix:
Gender:M
Credentials:RPH, PHARMD, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 W 4TH ST # 12
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:TX
Mailing Address - Zip Code:76520-3104
Mailing Address - Country:US
Mailing Address - Phone:254-697-6583
Mailing Address - Fax:
Practice Address - Street 1:1605 W 4TH ST # 12
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:TX
Practice Address - Zip Code:76520-3104
Practice Address - Country:US
Practice Address - Phone:254-697-6583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-27
Last Update Date:2021-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51158183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist