=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487453619
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VU HOANG
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/11/2025
-----------------------------------------------------
Last Update Date | 03/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 860 DULUTH HWY STE 150
-----------------------------------------------------
City | LAWRENCEVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30043-5336
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-274-6655
-----------------------------------------------------
Fax | 770-264-6520
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1560 CHADWICK DR
-----------------------------------------------------
City | LAWRENCEVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30043-7092
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-814-7966
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PS58912
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------