Healthcare Provider Details

I. General information

NPI: 1083926489
Provider Name (Legal Business Name): MRS. CAMMY HOANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2010
Last Update Date: 07/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 GALLIVAN BLVD
DORCHESTER CENTER MA
02124-5400
US

IV. Provider business mailing address

540 GALLIVAN BLVD
DORCHESTER CENTER MA
02124-5400
US

V. Phone/Fax

Practice location:
  • Phone: 617-287-9301
  • Fax:
Mailing address:
  • Phone: 617-287-9301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH25409
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: