Healthcare Provider Details

I. General information

NPI: 1891395190
Provider Name (Legal Business Name): TRI HUU HOANG PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2020
Last Update Date: 10/27/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3615 S RAINBOW BLVD
LAS VEGAS NV
89103-1057
US

IV. Provider business mailing address

3656 DUTCH VALLEY DR
LAS VEGAS NV
89147-6806
US

V. Phone/Fax

Practice location:
  • Phone: 702-367-6113
  • Fax:
Mailing address:
  • Phone: 702-577-8134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15874
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: