Healthcare Provider Details

I. General information

NPI: 1427884998
Provider Name (Legal Business Name): HONG LIEN THI HOANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2024
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3750 CHEMAWA RD NE
SALEM OR
97305-1119
US

IV. Provider business mailing address

3750 CHEMAWA RD NE
SALEM OR
97305-1119
US

V. Phone/Fax

Practice location:
  • Phone: 503-304-7602
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number61461017
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0020075
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: