Provider Demographics
NPI:1215647490
Name:DUONG, CO MAI (RPH)
Entity type:Individual
Prefix:
First Name:CO
Middle Name:MAI
Last Name:DUONG
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 1:5823 ZOLLER CT
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-8365
Mailing Address - Country:US
Mailing Address - Phone:916-293-1530
Mailing Address - Fax:
Practice Address - Street 1:5823 ZOLLER CT
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757-8365
Practice Address - Country:US
Practice Address - Phone:916-293-1530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87195183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist