Healthcare Provider Details

I. General information

NPI: 1558807248
Provider Name (Legal Business Name): CHI HOANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2017
Last Update Date: 01/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

644 W PUTNAM AVE
GREENWICH CT
06830-6088
US

IV. Provider business mailing address

644 W PUTNAM AVE
GREENWICH CT
06830-6088
US

V. Phone/Fax

Practice location:
  • Phone: 203-422-2022
  • Fax:
Mailing address:
  • Phone: 203-422-2022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPCT.0013280
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: