Healthcare Provider Details

I. General information

NPI: 1235502121
Provider Name (Legal Business Name): KRISTEN HOANG PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2015
Last Update Date: 01/10/2020
Certification Date: 01/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12251 DARNESTOWN RD
GAITHERSBURG MD
20878-2203
US

IV. Provider business mailing address

7836 GAMBRILL WOODS WAY
SPRINGFIELD VA
22153-2260
US

V. Phone/Fax

Practice location:
  • Phone: 301-417-0922
  • Fax:
Mailing address:
  • Phone: 703-644-1131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202213165
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number23434
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: