Provider Demographics
NPI:1093471062
Name:KHATIB, HOA HUYNH (RPH)
Entity Type:Individual
Prefix:
First Name:HOA
Middle Name:HUYNH
Last Name:KHATIB
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2303 PARKVIEW LN
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-9377
Mailing Address - Country:US
Mailing Address - Phone:612-802-4322
Mailing Address - Fax:
Practice Address - Street 1:1965 DONEGAL DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-4870
Practice Address - Country:US
Practice Address - Phone:651-735-0722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-12
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN125457183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist