Provider Demographics
NPI:1235568460
Name:HUYNH, KEANG H (RPH)
Entity Type:Individual
Prefix:
First Name:KEANG
Middle Name:H
Last Name:HUYNH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2521 ROUTE 130 SOUTH
Mailing Address - Street 2:
Mailing Address - City:CINNAMINSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08077
Mailing Address - Country:US
Mailing Address - Phone:856-303-2105
Mailing Address - Fax:856-303-2108
Practice Address - Street 1:2521 ROUTE 130 SOUTH
Practice Address - Street 2:
Practice Address - City:CINNAMINSON
Practice Address - State:NJ
Practice Address - Zip Code:08077
Practice Address - Country:US
Practice Address - Phone:856-303-2105
Practice Address - Fax:856-303-2108
Is Sole Proprietor?:No
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02847300183500000X
VA0202204479183500000X
PARP045810R183500000X
DEA1-0004414183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist