MEDICARE: NGOC-HOA THI CHAU PHARMACIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PHY41190	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PHA411900	OTHER	CA	MEDICAL PROVIDER NUMBER
2	10037	OTHER	NV	PHARMACIST LICENSE
3	44458	OTHER	CA	PHARMACIST LICENSE
4	PHY44458	OTHER	CA	PHARMY LICENSE
5	0563393	OTHER	CA	NABP
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053332544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NGOC-HOA THI CHAU PHARMACIST

Provider Business Mailing Address
First Line	:	2559 S KING RD
Second Line	:	SUITE 10
City	:	SAN JOSE
State	:	CA
Zip	:	95122-1894
Country	:	US
Telephone Number	:	408-532-1490
Fax Number	:	408-532-0899

Provider Business Practice Location Address
First Line	:	2559 S KING RD
Second Line	:	SUITE 10
City	:	SAN JOSE
State	:	CA
Zip	:	95122-1894
Country	:	US
Telephone Number	:	408-532-1490
Fax Number	:	408-532-0899

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	03/07/2023

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