Provider Demographics
NPI:1558650150
Name:NGUYEN, NGOC PHAT HOANG
Entity Type:Individual
Prefix:
First Name:NGOC PHAT
Middle Name:HOANG
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:PHAT
Other - Middle Name:HOANG
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:31353 SUNSET OAKS LN
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-7093
Mailing Address - Country:US
Mailing Address - Phone:617-820-4084
Mailing Address - Fax:
Practice Address - Street 1:15270 HIGHWAY 105 W
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77356-5684
Practice Address - Country:US
Practice Address - Phone:936-588-0666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-04
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX56031183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty