Provider Demographics
NPI:1003377037
Name:HOANG, MINHQUAN BA (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:MINHQUAN
Middle Name:BA
Last Name:HOANG
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:466 BEACH ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-3210
Mailing Address - Country:US
Mailing Address - Phone:949-207-8066
Mailing Address - Fax:
Practice Address - Street 1:807 S MAIN ST
Practice Address - Street 2:
Practice Address - City:YREKA
Practice Address - State:CA
Practice Address - Zip Code:96097-3320
Practice Address - Country:US
Practice Address - Phone:530-842-5596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-31
Last Update Date:2019-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80310183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist