Healthcare Provider Details

I. General information

NPI: 1669035044
Provider Name (Legal Business Name): CRYSTAL HOANG PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2019
Last Update Date: 11/13/2020
Certification Date: 11/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21365 SW BALER WAY
SHERWOOD OR
97140-8989
US

IV. Provider business mailing address

21365 SW BALER WAY
SHERWOOD OR
97140-8989
US

V. Phone/Fax

Practice location:
  • Phone: 503-610-6001
  • Fax: 503-610-9195
Mailing address:
  • Phone: 503-610-6001
  • Fax: 503-610-9195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number77949
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16844
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: