Provider Demographics
NPI:1962166900
Name:HOANG, KHANH
Entity type:Individual
Prefix:
First Name:KHANH
Middle Name:
Last Name:HOANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 ENTERPRISE WAY NW APT 6109
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35806-3252
Mailing Address - Country:US
Mailing Address - Phone:256-289-3739
Mailing Address - Fax:
Practice Address - Street 1:1100 ENTERPRISE WAY NW APT 6109
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35806-3252
Practice Address - Country:US
Practice Address - Phone:972-689-7889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19190183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL19190OtherALABAMA PHARMACIST LICENSE