Provider Demographics
NPI:1225022874
Name:O'SHEA, VICTORIA HOANG-MAI (RPH)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:HOANG-MAI
Last Name:O'SHEA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:HOANG-MAI
Other - Last Name:COOMES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:2817 REILLY ST
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:NC
Mailing Address - Zip Code:28310-7324
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2817 REILLY ST
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-7324
Practice Address - Country:US
Practice Address - Phone:910-907-6337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2015-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH017946183500000X
HIPH-3101183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist