Provider Demographics
NPI:1063885804
Name:HO, LAC-THU TRONG (RPH)
Entity type:Individual
Prefix:
First Name:LAC-THU
Middle Name:TRONG
Last Name:HO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8915 TOWNE CENTRE DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-5650
Mailing Address - Country:US
Mailing Address - Phone:858-550-9066
Mailing Address - Fax:858-550-9535
Practice Address - Street 1:8915 TOWNE CENTRE DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-5650
Practice Address - Country:US
Practice Address - Phone:858-550-9066
Practice Address - Fax:858-550-9535
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA69011183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist