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NPI Code Detail

MEDICARE: QUANG PHUNG HOANG PHARMD, BCCCP

MEDICARE: QUANG PHUNG HOANG PHARMD, BCCCP
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
11835C0205XCritical Care Pharmacist8032933-1701UT

General Provider Information

NPI Number : 1750250171
Entity Type Code : Individual
Provider Name (Legal Business Name) : QUANG PHUNG HOANG PHARMD, BCCCP
Provider Business Mailing Address
First Line : 201 E SOUTH TEMPLE APT 125
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84111-1267
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5121 S COTTONWOOD ST
Second Line :
City : MURRAY
State : UT
Zip : 84107-5701
Country : US
Telephone Number : 801-507-7000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/03/2025
Last Update Date : 11/03/2025

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