Provider Demographics
NPI:1063793404
Name:HOANG, JACQUELINE (PHARMD)
Entity type:Individual
Prefix:
First Name:JACQUELINE
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 1:2605 MIDDLEFIELD RD
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-2516
Mailing Address - Country:US
Mailing Address - Phone:650-566-9723
Mailing Address - Fax:650-566-9726
Practice Address - Street 1:2605 MIDDLEFIELD RD
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-2516
Practice Address - Country:US
Practice Address - Phone:650-566-9723
Practice Address - Fax:650-566-9726
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54866183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1598770828Medicare UPIN