Provider Demographics
NPI:1588005722
Name:HOANG, PHUONG MY (PHARMD)
Entity Type:Individual
Prefix:
First Name:PHUONG
Middle Name:MY
Last Name:HOANG
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 1:7386 TRIBBLE GAP RD
Mailing Address - Street 2:
Mailing Address - City:ALTO
Mailing Address - State:GA
Mailing Address - Zip Code:30510-2108
Mailing Address - Country:US
Mailing Address - Phone:678-200-4948
Mailing Address - Fax:
Practice Address - Street 1:2750 BUFORD HWY
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-2867
Practice Address - Country:US
Practice Address - Phone:770-622-6756
Practice Address - Fax:770-622-6765
Is Sole Proprietor?:No
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA027330183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist