Healthcare Provider Details

I. General information

NPI: 1164709622
Provider Name (Legal Business Name): THUY T HOANG PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2011
Last Update Date: 11/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 W CENTRAL AVE
PETAL MS
39465-2313
US

IV. Provider business mailing address

50 TWIN LAKE XING
HATTIESBURG MS
39401-0700
US

V. Phone/Fax

Practice location:
  • Phone: 601-554-3236
  • Fax: 601-554-9781
Mailing address:
  • Phone: 601-447-1111
  • Fax: 601-554-9781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberE-010022
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: