Healthcare Provider Details

I. General information

NPI: 1790151603
Provider Name (Legal Business Name): THANHTHUY THI HOANG PHARM. D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2015
Last Update Date: 08/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

895 HOLCOMB BRIDGE RD
ROSWELL GA
30076-1954
US

IV. Provider business mailing address

895 HOLCOMB BRIDGE RD
ROSWELL GA
30076-1954
US

V. Phone/Fax

Practice location:
  • Phone: 770-993-0194
  • Fax:
Mailing address:
  • Phone: 770-993-0194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH020744
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: