Healthcare Provider Details

I. General information

NPI: 1154929487
Provider Name (Legal Business Name): THANH DUY HOANG RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2020
Last Update Date: 10/09/2020
Certification Date: 10/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 FURNITURE DR
CORNELIA GA
30531
US

IV. Provider business mailing address

3708 FERN CREEK DR
FLOWERY BRANCH GA
30542-5752
US

V. Phone/Fax

Practice location:
  • Phone: 706-778-0353
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH031962
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: