Healthcare Provider Details

I. General information

NPI: 1669774865
Provider Name (Legal Business Name): HA T HOANG PHARM D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2010
Last Update Date: 11/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 EAST MERIDIAN
MILTON WA
98354
US

IV. Provider business mailing address

900 E MERIDIAN
MILTON WA
98354
US

V. Phone/Fax

Practice location:
  • Phone: 253-952-0390
  • Fax:
Mailing address:
  • Phone: 253-952-0390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00054116
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: