Healthcare Provider Details

I. General information

NPI: 1336885177
Provider Name (Legal Business Name): PAUL HOANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2022
Last Update Date: 05/05/2022
Certification Date: 05/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16622 E COLISEUM AVE
BATON ROUGE LA
70816-1857
US

IV. Provider business mailing address

16622 E COLISEUM AVE
BATON ROUGE LA
70816-1857
US

V. Phone/Fax

Practice location:
  • Phone: 225-241-0375
  • Fax:
Mailing address:
  • Phone: 225-241-0375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH8060
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: