Provider Demographics
NPI:1942802392
Name:HENG, POU VISOTH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:POU
Middle Name:VISOTH
Last Name:HENG
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 1:2425 CENTREVILLE RD
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-3013
Mailing Address - Country:US
Mailing Address - Phone:703-689-2570
Mailing Address - Fax:844-411-6521
Practice Address - Street 1:2425 CENTREVILLE RD
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-3013
Practice Address - Country:US
Practice Address - Phone:703-689-2570
Practice Address - Fax:844-411-6521
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202204277183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist