Provider Demographics
NPI:1285964403
Name:TRUONG, KHANH LAN (PHARM D)
Entity type:Individual
Prefix:
First Name:KHANH LAN
Middle Name:
Last Name:TRUONG
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:CONNIE
Other - Middle Name:
Other - Last Name:TRUONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARM D
Mailing Address - Street 1:3200 E SPEEDWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-3934
Mailing Address - Country:US
Mailing Address - Phone:520-327-1329
Mailing Address - Fax:520-327-7958
Practice Address - Street 1:3200 E SPEEDWAY BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-3934
Practice Address - Country:US
Practice Address - Phone:520-327-1329
Practice Address - Fax:520-327-7958
Is Sole Proprietor?:No
Enumeration Date:2010-01-11
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS011399183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist