Healthcare Provider Details

I. General information

NPI: 1174899843
Provider Name (Legal Business Name): PENI HOANG PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2012
Last Update Date: 03/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 CENTER DR
SAN MARCOS CA
92069-3536
US

IV. Provider business mailing address

725 CENTER DR
SAN MARCOS CA
92078
US

V. Phone/Fax

Practice location:
  • Phone: 760-871-6868
  • Fax: 760-871-6869
Mailing address:
  • Phone: 760-871-6868
  • Fax: 760-871-6869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number51777
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: