Healthcare Provider Details

I. General information

NPI: 1043709082
Provider Name (Legal Business Name): MY HOANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2018
Last Update Date: 05/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40130 10TH ST W
PALMDALE CA
93551-3005
US

IV. Provider business mailing address

4385 W AVENUE M11
LANCASTER CA
93536-2499
US

V. Phone/Fax

Practice location:
  • Phone: 661-267-6496
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number55833
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: