Provider Demographics
NPI:1265032999
Name:HO, QUANG NHAT (PHARMD)
Entity Type:Individual
Prefix:
First Name:QUANG
Middle Name:NHAT
Last Name:HO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4420 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73109-3414
Mailing Address - Country:US
Mailing Address - Phone:405-632-3742
Mailing Address - Fax:405-637-6730
Practice Address - Street 1:4420 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-3414
Practice Address - Country:US
Practice Address - Phone:405-632-3742
Practice Address - Fax:405-637-6730
Is Sole Proprietor?:No
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15275183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist