Healthcare Provider Details

I. General information

NPI: 1942788666
Provider Name (Legal Business Name): THAO HOANG PHARM.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2018
Last Update Date: 07/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3970 N STOCKTON HILL RD
KINGMAN AZ
86409-3002
US

IV. Provider business mailing address

955 CALUMET AVE APT B
KINGMAN AZ
86409-3702
US

V. Phone/Fax

Practice location:
  • Phone: 928-681-4903
  • Fax: 928-682-4911
Mailing address:
  • Phone: 714-548-0807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS023782
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: