Provider Demographics
NPI:1477158376
Name:HODOAN, KHANH (PHARMD)
Entity Type:Individual
Prefix:
First Name:KHANH
Middle Name:
Last Name:HODOAN
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 1:122 WINTERBERRY WAY
Mailing Address - Street 2:
Mailing Address - City:DEPTFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-5558
Mailing Address - Country:US
Mailing Address - Phone:856-217-5633
Mailing Address - Fax:
Practice Address - Street 1:24 S BLACK HORSE PIKE
Practice Address - Street 2:
Practice Address - City:MOUNT EPHRAIM
Practice Address - State:NJ
Practice Address - Zip Code:08059-1321
Practice Address - Country:US
Practice Address - Phone:856-931-6262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02946900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist