Healthcare Provider Details

I. General information

NPI: 1336468057
Provider Name (Legal Business Name): LOAN KIM THI HOANG RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2010
Last Update Date: 05/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 CHURCH ST N
CONCORD NC
28025-4321
US

IV. Provider business mailing address

690 CHURCH ST N
CONCORD NC
28025-4321
US

V. Phone/Fax

Practice location:
  • Phone: 704-782-2194
  • Fax: 704-784-3815
Mailing address:
  • Phone: 704-782-2194
  • Fax: 704-784-3815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9583
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: