Healthcare Provider Details

I. General information

NPI: 1831467828
Provider Name (Legal Business Name): THANH XUAN HOANG PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2011
Last Update Date: 12/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 E BROAD ST
BRIDGETON NJ
08302-2503
US

IV. Provider business mailing address

25 E BROAD ST
BRIDGETON NJ
08302-2503
US

V. Phone/Fax

Practice location:
  • Phone: 856-459-2402
  • Fax: 856-459-2408
Mailing address:
  • Phone: 856-459-2402
  • Fax: 856-459-2408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI03302800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: