Provider Demographics
NPI:1699250308
Name:TRUONG, PAOLO V (PHARM D)
Entity type:Individual
Prefix:
First Name:PAOLO
Middle Name:V
Last Name:TRUONG
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 E VALLEY BLVD # 279
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-3549
Mailing Address - Country:US
Mailing Address - Phone:626-328-0057
Mailing Address - Fax:
Practice Address - Street 1:735 S FIGUEROA ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-2571
Practice Address - Country:US
Practice Address - Phone:213-330-4543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-27
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79105183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist