Provider Demographics
NPI:1336468057
Name:HOANG, LOAN KIM THI (RPH)
Entity Type:Individual
Prefix:
First Name:LOAN
Middle Name:KIM THI
Last Name:HOANG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 CHURCH ST N
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-4321
Mailing Address - Country:US
Mailing Address - Phone:704-782-2194
Mailing Address - Fax:704-784-3815
Practice Address - Street 1:690 CHURCH ST N
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-4321
Practice Address - Country:US
Practice Address - Phone:704-782-2194
Practice Address - Fax:704-784-3815
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-20
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9583183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist