Healthcare Provider Details

I. General information

NPI: 1568322303
Provider Name (Legal Business Name): JACK JIXIANG HUANG RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2025
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 HOSPITAL DR
MADISONVILLE KY
42431-1644
US

IV. Provider business mailing address

1053 SADDLEBROOK DR APT C
HENDERSON KY
42420-6011
US

V. Phone/Fax

Practice location:
  • Phone: 270-825-5100
  • Fax:
Mailing address:
  • Phone: 513-846-2136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number025503
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: