Healthcare Provider Details

I. General information

NPI: 1083173355
Provider Name (Legal Business Name): HOA NGUYEN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2019
Last Update Date: 03/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6820 CENTENNIAL BLVD
COLORADO SPRINGS CO
80919-5114
US

IV. Provider business mailing address

6820 CENTENNIAL BLVD
COLORADO SPRINGS CO
80919-5114
US

V. Phone/Fax

Practice location:
  • Phone: 719-264-1665
  • Fax: 719-264-6772
Mailing address:
  • Phone: 719-264-1665
  • Fax: 719-264-6772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHA.22040
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: