Healthcare Provider Details

I. General information

NPI: 1578285300
Provider Name (Legal Business Name): SONNY HOANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 09/19/2022
Certification Date: 09/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5405 MILLS CIVIC PKWY
WEST DES MOINES IA
50266-5303
US

IV. Provider business mailing address

12609 WINSTON AVE
URBANDALE IA
50323-2381
US

V. Phone/Fax

Practice location:
  • Phone: 515-223-3597
  • Fax:
Mailing address:
  • Phone: 515-707-4515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number24589
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: