Healthcare Provider Details

I. General information

NPI: 1528657079
Provider Name (Legal Business Name): PETER HUANG PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2021
Last Update Date: 01/11/2021
Certification Date: 01/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5101 LEE HWY
ARLINGTON VA
22207-1603
US

IV. Provider business mailing address

10409 DEERFOOT DR
GREAT FALLS VA
22066-3416
US

V. Phone/Fax

Practice location:
  • Phone: 703-522-3412
  • Fax: 703-522-3414
Mailing address:
  • Phone: 703-966-5556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202212193
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: