Provider Demographics
NPI:1942788666
Name:HOANG, THAO (PHARMD)
Entity Type:Individual
Prefix:
First Name:THAO
Middle Name:
Last Name:HOANG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 CALUMET AVE APT B
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-3702
Mailing Address - Country:US
Mailing Address - Phone:714-548-0807
Mailing Address - Fax:
Practice Address - Street 1:3970 N STOCKTON HILL RD
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409-3002
Practice Address - Country:US
Practice Address - Phone:928-681-4903
Practice Address - Fax:928-682-4911
Is Sole Proprietor?:No
Enumeration Date:2018-08-03
Last Update Date:2019-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS023782183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist