MEDICARE: MO HOANG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RP452437	PA

General Provider Information

NPI Number	:	1467050252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MO HOANG

Provider Business Mailing Address
First Line	:	130 S CAROL BLVD
Second Line	:
City	:	UPPER DARBY
State	:	PA
Zip	:	19082-2814
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5214 BALTIMORE AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19143-3240
Country	:	US
Telephone Number	:	215-476-1724
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2020
Last Update Date	:	10/13/2020

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Directions to “ MO HOANG ” Practice Location

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