Healthcare Provider Details

I. General information

NPI: 1174364780
Provider Name (Legal Business Name): SANGHO HAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2024
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25401 N LAKE PLEASANT PKWY
PEORIA AZ
85383-1351
US

IV. Provider business mailing address

14221 W HACKAMORE DR
SURPRISE AZ
85387-1940
US

V. Phone/Fax

Practice location:
  • Phone: 623-235-2360
  • Fax:
Mailing address:
  • Phone: 972-603-6685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberS026998
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: