Healthcare Provider Details

I. General information

NPI: 1669864849
Provider Name (Legal Business Name): MIMI HOANG PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2015
Last Update Date: 02/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 CHINO HILLS PKWY STE 500
CHINO HILLS CA
91709-3779
US

IV. Provider business mailing address

14 MIDNIGHT SUN
IRVINE CA
92603-4265
US

V. Phone/Fax

Practice location:
  • Phone: 909-393-5710
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH58300
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: