Provider Demographics
NPI:1730864778
Name:TRUONG, THOMAS GIA LONG
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:GIA LONG
Last Name:TRUONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 CAPE HARBOUR LOOP UNIT 106
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34212-2139
Mailing Address - Country:US
Mailing Address - Phone:239-826-5453
Mailing Address - Fax:
Practice Address - Street 1:5945 US HIGHWAY 301 N
Practice Address - Street 2:
Practice Address - City:ELLENTON
Practice Address - State:FL
Practice Address - Zip Code:34222-2953
Practice Address - Country:US
Practice Address - Phone:941-722-2884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS65520183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist