Provider Demographics
NPI:1487255345
Name:HOANG, BOBBY
Entity type:Individual
Prefix:
First Name:BOBBY
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 1:8700 W TRAIL LAKE DR STE 205
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-8205
Mailing Address - Country:US
Mailing Address - Phone:190-128-9807
Mailing Address - Fax:
Practice Address - Street 1:8700 W TRAIL LAKE DR STE 205
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-8205
Practice Address - Country:US
Practice Address - Phone:901-289-8075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29711183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist