Provider Demographics
NPI:1730635541
Name:TRUONG, CAROLYN KIMLEE (PHARMD, BCPS)
Entity type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:KIMLEE
Last Name:TRUONG
Suffix:
Gender:F
Credentials:PHARMD, BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 S CLARK ST
Mailing Address - Street 2:UNIT 501
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2155
Mailing Address - Country:US
Mailing Address - Phone:949-466-3762
Mailing Address - Fax:
Practice Address - Street 1:1000 S CLARK ST
Practice Address - Street 2:UNIT 501
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-2155
Practice Address - Country:US
Practice Address - Phone:949-466-3762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA741871835P0018X
IN26025640A1835P0018X
IL31520101835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy