Healthcare Provider Details

I. General information

NPI: 1265917058
Provider Name (Legal Business Name): PETER HOANG PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2018
Last Update Date: 09/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13651 WILLARD STREET
PANORAMA CITY CA
91402
US

IV. Provider business mailing address

1312 W COMMONWEALTH AVE APT A
ALHAMBRA CA
91803-1747
US

V. Phone/Fax

Practice location:
  • Phone: 818-375-2873
  • Fax:
Mailing address:
  • Phone: 626-616-2996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number78732
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: