Provider Demographics
NPI:1184791626
Name:LUONG, VAN (PHARM D)
Entity type:Individual
Prefix:DR
First Name:VAN
Middle Name:
Last Name:LUONG
Suffix:
Gender:F
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 1:28353 MIRABELLE LN
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91350-3238
Mailing Address - Country:US
Mailing Address - Phone:661-296-2768
Mailing Address - Fax:
Practice Address - Street 1:7120 HAYVENHURST AVE STE 201
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-3813
Practice Address - Country:US
Practice Address - Phone:818-786-3110
Practice Address - Fax:818-786-3150
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 57532183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist