Provider Demographics
NPI:1134768864
Name:VANG, JOE (PHARMD, MHI)
Entity type:Individual
Prefix:DR
First Name:JOE
Middle Name:
Last Name:VANG
Suffix:
Gender:M
Credentials:PHARMD, MHI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:783 SHERBURNE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-2712
Mailing Address - Country:US
Mailing Address - Phone:612-961-8292
Mailing Address - Fax:
Practice Address - Street 1:550 VANDALIA ST STE 175
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-2019
Practice Address - Country:US
Practice Address - Phone:651-313-6733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-28
Last Update Date:2019-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN124307183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist