Provider Demographics
NPI:1174899843
Name:HOANG, PENI (PHARMD)
Entity type:Individual
Prefix:
First Name:PENI
Middle Name:
Last Name:HOANG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 CENTER DR
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078
Mailing Address - Country:US
Mailing Address - Phone:760-871-6868
Mailing Address - Fax:760-871-6869
Practice Address - Street 1:725 CENTER DR
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-3536
Practice Address - Country:US
Practice Address - Phone:760-871-6868
Practice Address - Fax:760-871-6869
Is Sole Proprietor?:No
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51777183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist