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General NPI Number Information
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NPI Number | 1689149684
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Entity Type | Individual
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Provider Name | PHUONG MAI HOANG PHARMD
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Gender | Female
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Dates
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Enumeration Date | 10/05/2018
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Last Update Date | 07/31/2019
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Provider Practice Location Address
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Address Line | 101 NACO RD
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City | BISBEE
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State | AZ
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Zip | 85603-9655
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Country | US
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Telephone | 703-340-9101
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Fax |
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Provider Business Mailing Address
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Address Line | 101 NACO RD
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City | BISBEE
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State | AZ
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Zip | 85603-9655
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Country | US
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Telephone | 703-340-9101
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RP452612
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | S023769
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License Number State | AZ
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