Healthcare Provider Details

I. General information

NPI: 1760773121
Provider Name (Legal Business Name): BAO HOANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2011
Last Update Date: 04/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 PENN AVE
WEST READING PA
19611-1080
US

IV. Provider business mailing address

18 FAIR MEADOW DR
DOUGLASSVILLE PA
19518-1144
US

V. Phone/Fax

Practice location:
  • Phone: 610-373-5241
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP443055
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: