Provider Demographics
NPI:1235411430
Name:HO, TUONG C
Entity Type:Individual
Prefix:
First Name:TUONG
Middle Name:C
Last Name:HO
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 1:880 N MONTELLO ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-1655
Mailing Address - Country:US
Mailing Address - Phone:508-894-3061
Mailing Address - Fax:508-894-8925
Practice Address - Street 1:880 N MONTELLO ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1655
Practice Address - Country:US
Practice Address - Phone:508-894-3061
Practice Address - Fax:508-894-8925
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH26821183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist