MEDICARE: THY NGOC THI 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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	35627	TX

General Provider Information

NPI Number	:	1740883305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THY NGOC THI HOANG

Provider Business Mailing Address
First Line	:	3305 DALLAS PKWY
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-7797
Country	:	US
Telephone Number	:	972-608-4694
Fax Number	:

Provider Business Practice Location Address
First Line	:	3305 DALLAS PKWY
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-7797
Country	:	US
Telephone Number	:	972-608-4694
Fax Number	:

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

Provider Enumeration Date	:	11/17/2020
Last Update Date	:	11/17/2020

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