Provider Demographics
NPI:1093953432
Name:HOANG, HAO (PHARM D)
Entity Type:Individual
Prefix:
First Name:HAO
Middle Name:
Last Name:HOANG
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8112 SHELDON RD STE 300
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758
Mailing Address - Country:US
Mailing Address - Phone:916-684-9922
Mailing Address - Fax:916-684-9499
Practice Address - Street 1:8112 SHELDON RD STE 300
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758
Practice Address - Country:US
Practice Address - Phone:916-684-9922
Practice Address - Fax:916-684-9499
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-22
Last Update Date:2024-01-04
Deactivation Date:2017-05-25
Deactivation Code:
Reactivation Date:2023-11-14
Provider Licenses
StateLicense IDTaxonomies
CARPH80683183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5633133OtherNCPDP