Provider Demographics
NPI:1760088702
Name:HOANG, KADIE KHOA
Entity Type:Individual
Prefix:MISS
First Name:KADIE
Middle Name:KHOA
Last Name:HOANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10041 OAK QUARRY DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-5645
Mailing Address - Country:US
Mailing Address - Phone:714-363-8391
Mailing Address - Fax:
Practice Address - Street 1:10041 OAK QUARRY DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-5645
Practice Address - Country:US
Practice Address - Phone:714-363-8391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-06
Last Update Date:2020-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS60443183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist