Healthcare Provider Details

I. General information

NPI: 1962166900
Provider Name (Legal Business Name): KHANH HOANG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2021
Last Update Date: 10/26/2021
Certification Date: 10/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 ENTERPRISE WAY NW APT 6109
HUNTSVILLE AL
35806-3252
US

IV. Provider business mailing address

1100 ENTERPRISE WAY NW APT 6109
HUNTSVILLE AL
35806-3252
US

V. Phone/Fax

Practice location:
  • Phone: 972-689-7889
  • Fax:
Mailing address:
  • Phone: 256-289-3739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number19190
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: