Healthcare Provider Details

I. General information

NPI: 1447707641
Provider Name (Legal Business Name): NGOCANH HOANG NGUYEN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2016
Last Update Date: 09/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2266 WYOMING BLVD NE
ALBUQUERQUE NM
87112-2620
US

IV. Provider business mailing address

1528 CORNELL DR SE
ALBUQUERQUE NM
87106-3304
US

V. Phone/Fax

Practice location:
  • Phone: 505-323-2885
  • Fax:
Mailing address:
  • Phone: 505-615-5433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00008579
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: