Provider Demographics
NPI:1962007930
Name:VANG, SCOTT CHONKAO (RPH)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:CHONKAO
Last Name:VANG
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3179 12TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-9666
Mailing Address - Country:US
Mailing Address - Phone:336-553-8255
Mailing Address - Fax:
Practice Address - Street 1:4310 W WENDOVER AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-1911
Practice Address - Country:US
Practice Address - Phone:336-294-0335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29941183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist