MEDICARE: DR. NGOC MY LA PHARMD

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	64939	CA

General Provider Information

NPI Number	:	1336512227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NGOC MY LA PHARMD

Provider Business Mailing Address
First Line	:	18450 LOMOND WAY
Second Line	:
City	:	CASTRO VALLEY
State	:	CA
Zip	:	94552-1826
Country	:	US
Telephone Number	:	510-368-0246
Fax Number	:

Provider Business Practice Location Address
First Line	:	699 LEWELLING BLVD
Second Line	:
City	:	SAN LEANDRO
State	:	CA
Zip	:	94579-1870
Country	:	US
Telephone Number	:	510-351-0951
Fax Number	:

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

Provider Enumeration Date	:	11/02/2015
Last Update Date	:	12/12/2019

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