Provider Demographics
NPI:1174019970
Name:HUOT, SENG SOPHIA
Entity Type:Individual
Prefix:MISS
First Name:SENG
Middle Name:SOPHIA
Last Name:HUOT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 HIGHLAND OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33559-7353
Mailing Address - Country:US
Mailing Address - Phone:813-429-6963
Mailing Address - Fax:813-803-7503
Practice Address - Street 1:1860 HIGHLAND OAKS BLVD
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33559-7353
Practice Address - Country:US
Practice Address - Phone:813-428-6963
Practice Address - Fax:813-803-7503
Is Sole Proprietor?:No
Enumeration Date:2018-07-03
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS52858183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist