Provider Demographics
NPI:1790394617
Name:HO, MICHAEL VAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:VAN
Last Name:HO
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 1:1240 KNOLL MIST LN
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-3232
Mailing Address - Country:US
Mailing Address - Phone:301-325-9023
Mailing Address - Fax:
Practice Address - Street 1:25 GRAND CORNER AVE
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-7305
Practice Address - Country:US
Practice Address - Phone:301-721-1830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27383183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist