Healthcare Provider Details

I. General information

NPI: 1588005722
Provider Name (Legal Business Name): PHUONG MY HOANG PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2013
Last Update Date: 07/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 BUFORD HWY
DULUTH GA
30096-2867
US

IV. Provider business mailing address

7386 TRIBBLE GAP RD
ALTO GA
30510-2108
US

V. Phone/Fax

Practice location:
  • Phone: 770-622-6756
  • Fax: 770-622-6765
Mailing address:
  • Phone: 678-200-4948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number027330
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: