=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689948812
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KHOI NGUYEN VO PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/06/2012
-----------------------------------------------------
Last Update Date | 03/06/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 885 E US HIGHWAY 60
-----------------------------------------------------
City | MONETT
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65708-9367
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-274-3953
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6507 HEARTHSTONE DR
-----------------------------------------------------
City | ROGERS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72758-4139
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-274-3953
-----------------------------------------------------
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 | PD11720
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 2011032869
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------