Healthcare Provider Details

I. General information

NPI: 1356984553
Provider Name (Legal Business Name): KHANH DINH PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2019
Last Update Date: 10/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 GAFFNEY RD STOP 7440
FT WAINWRIGHT AK
99703-5007
US

IV. Provider business mailing address

1060 GAFFNEY RD STOP 7440
FT WAINWRIGHT AK
99703-5007
US

V. Phone/Fax

Practice location:
  • Phone: 907-361-2317
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number52310
License Number StateTX

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: