Provider Demographics
NPI:1295005791
Name:HO, VAN ANH NGUYEN (PHARMD)
Entity Type:Individual
Prefix:
First Name:VAN ANH
Middle Name:NGUYEN
Last Name:HO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5002 TARI STREAM WAY
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-8416
Mailing Address - Country:US
Mailing Address - Phone:813-689-7580
Mailing Address - Fax:
Practice Address - Street 1:13323 BOYETTE RD
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33569-5728
Practice Address - Country:US
Practice Address - Phone:813-689-4498
Practice Address - Fax:813-689-4655
Is Sole Proprietor?:No
Enumeration Date:2011-12-31
Last Update Date:2011-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS34807183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist