Provider Demographics
NPI:1821014986
Name:HORNG, INC.
Entity Type:Organization
Organization Name:HORNG, INC.
Other - Org Name:PIONEER VALLEY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:WAN-JEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HORNG
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:801-964-3935
Mailing Address - Street 1:4052 PIONEER PKWY STE 111
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84120-2063
Mailing Address - Country:US
Mailing Address - Phone:801-964-3935
Mailing Address - Fax:801-964-3934
Practice Address - Street 1:4052 PIONEER PKWY STE 111
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84120-2063
Practice Address - Country:US
Practice Address - Phone:801-964-3935
Practice Address - Fax:801-964-3934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5004123-17033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========002Medicaid