Healthcare Provider Details

I. General information

NPI: 1700671740
Provider Name (Legal Business Name): CHAU HOANG PHARMD, RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2025
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

485 ARSENAL ST
WATERTOWN MA
02472-5091
US

IV. Provider business mailing address

30 HOMES AVE APT 2
DORCHESTER MA
02122-1062
US

V. Phone/Fax

Practice location:
  • Phone: 617-972-5100
  • Fax:
Mailing address:
  • Phone: 480-358-5212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH1000754
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: