=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174899843
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PENI HOANG PHARM.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2012
-----------------------------------------------------
Last Update Date | 03/28/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 725 CENTER DR
-----------------------------------------------------
City | SAN MARCOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92069-3536
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-871-6868
-----------------------------------------------------
Fax | 760-871-6869
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 725 CENTER DR
-----------------------------------------------------
City | SAN MARCOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92078
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-871-6868
-----------------------------------------------------
Fax | 760-871-6869
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 51777
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------