Provider Demographics
NPI:1053983452
Name:HOANG, NGOC (PHARMD)
Entity type:Individual
Prefix:
First Name:NGOC
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 1:1833 W PAMPAS LN # C205
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-1835
Mailing Address - Country:US
Mailing Address - Phone:505-620-8098
Mailing Address - Fax:
Practice Address - Street 1:43 W PRAIRIE SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-9854
Practice Address - Country:US
Practice Address - Phone:208-772-2774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP9403183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist