Healthcare Provider Details

I. General information

NPI: 1962777813
Provider Name (Legal Business Name): EVELYN-ANH TUONG HOANG PHARM. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2012
Last Update Date: 03/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 SUMMITRIDGE DR
DIAMOND BAR CA
91765-4364
US

IV. Provider business mailing address

1010 SUMMITRIDGE DR
DIAMOND BAR CA
91765-4364
US

V. Phone/Fax

Practice location:
  • Phone: 626-975-8441
  • Fax:
Mailing address:
  • Phone: 626-975-8441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number46679
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: