Healthcare Provider Details

I. General information

NPI: 1053983452
Provider Name (Legal Business Name): NGOC HOANG PHARM.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2021
Last Update Date: 07/14/2021
Certification Date: 07/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 W PRAIRIE SHOPPING CTR
HAYDEN ID
83835-9854
US

IV. Provider business mailing address

1833 W PAMPAS LN # C205
COEUR D ALENE ID
83815-1835
US

V. Phone/Fax

Practice location:
  • Phone: 208-772-2774
  • Fax:
Mailing address:
  • Phone: 505-620-8098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP9403
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: