Provider Demographics
NPI:1659951507
Name:VINH, HIEU BAO (RPH)
Entity Type:Individual
Prefix:
First Name:HIEU
Middle Name:BAO
Last Name:VINH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1365 DORCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02122-2915
Mailing Address - Country:US
Mailing Address - Phone:617-282-9800
Mailing Address - Fax:617-282-9814
Practice Address - Street 1:1365 DORCHESTER AVE
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02122-2915
Practice Address - Country:US
Practice Address - Phone:617-282-9800
Practice Address - Fax:617-282-9814
Is Sole Proprietor?:No
Enumeration Date:2021-04-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH23731183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist