Provider Demographics
NPI:1477838563
Name:HOSANG, JOAN H (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:H
Last Name:HOSANG
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 1:4402 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61103-1278
Mailing Address - Country:US
Mailing Address - Phone:815-987-7046
Mailing Address - Fax:815-987-7710
Practice Address - Street 1:4402 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61103-1278
Practice Address - Country:US
Practice Address - Phone:815-987-7046
Practice Address - Fax:815-987-7710
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051036594183500000X
OH03215710183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist