Provider Demographics
NPI:1407473895
Name:HO, BAOKHANH N
Entity Type:Individual
Prefix:
First Name:BAOKHANH
Middle Name:N
Last Name:HO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 DACULA RD
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-2125
Mailing Address - Country:US
Mailing Address - Phone:770-962-2077
Mailing Address - Fax:770-962-2171
Practice Address - Street 1:575 DACULA RD
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-2125
Practice Address - Country:US
Practice Address - Phone:770-962-2077
Practice Address - Fax:770-962-2171
Is Sole Proprietor?:No
Enumeration Date:2020-07-01
Last Update Date:2022-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH030263183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist