Provider Demographics
NPI:1962037903
Name:DO, CUONG MANH (PHARMD)
Entity type:Individual
Prefix:
First Name:CUONG
Middle Name:MANH
Last Name:DO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9351 TUDOR LN
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92841-3426
Mailing Address - Country:US
Mailing Address - Phone:714-553-7357
Mailing Address - Fax:
Practice Address - Street 1:37160 47TH ST E
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93552-4450
Practice Address - Country:US
Practice Address - Phone:661-236-0015
Practice Address - Fax:661-236-0057
Is Sole Proprietor?:No
Enumeration Date:2020-03-10
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51185183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist