Provider Demographics
NPI:1932400710
Name:BORKENHAGEN, QUYNH HUONG (PHARMD)
Entity type:Individual
Prefix:
First Name:QUYNH
Middle Name:HUONG
Last Name:BORKENHAGEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:QUYNH
Other - Middle Name:HUONG
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1440 N NIAGARA ST.
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505
Mailing Address - Country:US
Mailing Address - Phone:818-305-6024
Mailing Address - Fax:818-330-4550
Practice Address - Street 1:2514 N ONTARIO ST
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91504
Practice Address - Country:US
Practice Address - Phone:800-657-2212
Practice Address - Fax:818-330-4550
Is Sole Proprietor?:No
Enumeration Date:2010-11-09
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA68687183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARPH68687OtherCA BOP