Healthcare Provider Details

I. General information

NPI: 1346519022
Provider Name (Legal Business Name): HAOBO HUANG PHARM. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/24/2011
Last Update Date: 12/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3695 WINKLER AVENUE EXT APT 733
FORT MYERS FL
33916-9496
US

IV. Provider business mailing address

3695 WINKLER AVENUE EXT APT 733
FORT MYERS FL
33916-9496
US

V. Phone/Fax

Practice location:
  • Phone: 352-281-9776
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS46208
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: