Healthcare Provider Details

I. General information

NPI: 1629257803
Provider Name (Legal Business Name): DUAN XUAN HOANG PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2007
Last Update Date: 10/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4031 SW 71ST TER
DAVIE FL
33314-3169
US

IV. Provider business mailing address

4031 SW 71ST TER
DAVIE FL
33314-3169
US

V. Phone/Fax

Practice location:
  • Phone: 954-915-0785
  • Fax:
Mailing address:
  • Phone: 954-915-0785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number41384
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: