Provider Demographics
NPI:1366041956
Name:DOAN, BAO MINH (RPH)
Entity Type:Individual
Prefix:
First Name:BAO
Middle Name:MINH
Last Name:DOAN
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 1:200 FLOYD DR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:KY
Mailing Address - Zip Code:41008-8231
Mailing Address - Country:US
Mailing Address - Phone:502-732-0378
Mailing Address - Fax:502-732-8904
Practice Address - Street 1:200 FLOYD DR
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:KY
Practice Address - Zip Code:41008-8231
Practice Address - Country:US
Practice Address - Phone:502-732-0378
Practice Address - Fax:502-732-8904
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-23
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY019758183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist