Healthcare Provider Details

I. General information

NPI: 1386963916
Provider Name (Legal Business Name): MINH D HOANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2010
Last Update Date: 05/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4902 WESTFIELD AVE
PENNSAUKEN NJ
08110-2952
US

IV. Provider business mailing address

4902 WESTFIELD AVE
PENNSAUKEN NJ
08110-2952
US

V. Phone/Fax

Practice location:
  • Phone: 856-662-3496
  • Fax: 856-486-7249
Mailing address:
  • Phone: 856-662-3496
  • Fax: 856-486-7249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI02900800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: