Healthcare Provider Details

I. General information

NPI: 1174019970
Provider Name (Legal Business Name): MISS SENG SOPHIA HUOT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2018
Last Update Date: 07/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 HIGHLAND OAKS BLVD
LUTZ FL
33559-7353
US

IV. Provider business mailing address

1860 HIGHLAND OAKS BLVD
LUTZ FL
33559-7353
US

V. Phone/Fax

Practice location:
  • Phone: 813-428-6963
  • Fax: 813-803-7503
Mailing address:
  • Phone: 813-429-6963
  • Fax: 813-803-7503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS52858
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: