Provider Demographics
NPI:1679321160
Name:TAN, HOANG ANH (PHARMD)
Entity type:Individual
Prefix:
First Name:HOANG ANH
Middle Name:
Last Name:TAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:ANH
Other - Middle Name:HOANG
Other - Last Name:TAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:143 CAYMEN CT
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-1423
Mailing Address - Country:US
Mailing Address - Phone:404-518-8918
Mailing Address - Fax:
Practice Address - Street 1:143 CAYMEN CT
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-1423
Practice Address - Country:US
Practice Address - Phone:404-518-8918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA034750183500000X
GARPH034750183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist