Active NPI
Phuoc Truong
- Pharmacist
- Jacksonville, FL
National Provider Identifier
1356946842
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS61501
- Practice address
- 3634 Rogero Rd
Jacksonville, FL 32277-2556 - Phone
- (904) 744-8414
- NPI assigned
- Dec 2, 2020
- Last updated
- Dec 2, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PS61501 | FL | Primary |
Addresses
Primary practice location
3634 Rogero Rd
Jacksonville, FL 32277-2556
Mailing address
8714 Star Leaf Rd N
Jacksonville, FL 32210-9641
Phone (904) 703-4896
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS61501 | FL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1606867200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1606867200000",
"number": "1356946842",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8714 STAR LEAF RD N",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322109641",
"telephone_number": "904-703-4896"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3634 ROGERO RD",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322772556",
"telephone_number": "904-744-8414"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TRUONG",
"first_name": "PHUOC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-12-02",
"last_updated": "2020-12-02",
"certification_date": "2020-11-26",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS61501",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.