Provider Demographics
NPI:1821861675
Name:HOANG, THAO THI PHUONG
Entity Type:Individual
Prefix:
First Name:THAO
Middle Name:THI PHUONG
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 1:3843 122ND ST
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50323-2303
Mailing Address - Country:US
Mailing Address - Phone:515-918-6010
Mailing Address - Fax:
Practice Address - Street 1:6365 STAGECOACH DR
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8083
Practice Address - Country:US
Practice Address - Phone:515-453-2760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA24897183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist