Provider Demographics
NPI:1871878017
Name:DUONG, MICHELL M (PHARM D)
Entity type:Individual
Prefix:
First Name:MICHELL
Middle Name:M
Last Name:DUONG
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 1:2585 ALMADEN RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-3603
Mailing Address - Country:US
Mailing Address - Phone:408-723-9905
Mailing Address - Fax:408-723-4931
Practice Address - Street 1:2585 ALMADEN RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-3603
Practice Address - Country:US
Practice Address - Phone:408-723-9905
Practice Address - Fax:408-723-4931
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH42768183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist