Provider Demographics
NPI:1689948812
Name:VO, KHOI NGUYEN (PHARMD)
Entity Type:Individual
Prefix:
First Name:KHOI
Middle Name:NGUYEN
Last Name:VO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6507 HEARTHSTONE DR
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-4139
Mailing Address - Country:US
Mailing Address - Phone:626-274-3953
Mailing Address - Fax:
Practice Address - Street 1:885 E US HIGHWAY 60
Practice Address - Street 2:
Practice Address - City:MONETT
Practice Address - State:MO
Practice Address - Zip Code:65708-9367
Practice Address - Country:US
Practice Address - Phone:626-274-3953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD11720183500000X
MO2011032869183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist