Provider Demographics
NPI:1215304498
Name:HOANG TRUONG LLC
Entity type:Organization
Organization Name:HOANG TRUONG LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:THINH
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUONG
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:281-564-5400
Mailing Address - Street 1:8388 W SAM HOUSTON PKWY S STE 186
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77072-5081
Mailing Address - Country:US
Mailing Address - Phone:281-564-5400
Mailing Address - Fax:281-564-5404
Practice Address - Street 1:8388 W SAM HOUSTON PKWY S STE 186
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77072-5081
Practice Address - Country:US
Practice Address - Phone:281-564-5400
Practice Address - Fax:281-564-5404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-24
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX301303336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2154364OtherPK
TX148013Medicaid