Provider Demographics
NPI:1962760116
Name:HOANG, MONGTRUC (PHARM D)
Entity type:Individual
Prefix:
First Name:MONGTRUC
Middle Name:
Last Name:HOANG
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4958 CORSICA PL
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70129-1528
Mailing Address - Country:US
Mailing Address - Phone:504-644-8113
Mailing Address - Fax:
Practice Address - Street 1:2090 GAUSE BLVD E
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-5431
Practice Address - Country:US
Practice Address - Phone:985-641-3847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPNT.045985183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist