Healthcare Provider Details

I. General information

NPI: 1497359335
Provider Name (Legal Business Name): KIMBERLY TUYET HOANG PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2020
Last Update Date: 11/22/2020
Certification Date: 11/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 S BROADWAY
SALEM NH
03079-4306
US

IV. Provider business mailing address

512 S BROADWAY
SALEM NH
03079-4306
US

V. Phone/Fax

Practice location:
  • Phone: 603-898-5983
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH239032
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHCY-00916
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: