Individual
PETER KHONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMACIST
Contact information
Practice address
2915 US-190, MANDEVILLE, LA 70461
(985) 626-8106
Mailing address
1121 WYNDHAM S, GRETNA, LA 70056-8371
(402) 913-7437
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
023215
LA
Other
Enumeration date
09/20/2019
Last updated
09/20/2019
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