Healthcare Provider Details

I. General information

NPI: 1447502208
Provider Name (Legal Business Name): KIM HOANG NGUYEN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2012
Last Update Date: 04/07/2020
Certification Date: 04/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13845 CONLAN CIR
CHARLOTTE NC
28277-2705
US

IV. Provider business mailing address

13845 CONLAN CIR
CHARLOTTE NC
28277-2705
US

V. Phone/Fax

Practice location:
  • Phone: 704-544-2092
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number25268
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: