Provider Demographics
NPI:1366076895
Name:TRUONG, BAO T (PHARMD)
Entity type:Individual
Prefix:
First Name:BAO
Middle Name:T
Last Name:TRUONG
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 1:7740 RANCHO SANTA FE RD
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-8685
Mailing Address - Country:US
Mailing Address - Phone:760-753-5115
Mailing Address - Fax:
Practice Address - Street 1:7740 RANCHO SANTA FE RD
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-8685
Practice Address - Country:US
Practice Address - Phone:760-753-5115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-24
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81769183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist