MEDICARE: THU TRONG NGO 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	1835P1300X	Psychiatric Pharmacist	14421	NV
2	183500000X	Pharmacist	14421	NV

General Provider Information

NPI Number	:	1528577988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THU TRONG NGO PHARMACIST

Provider Business Mailing Address
First Line	:	1650 COMMUNITY COLLEGE DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-1144
Country	:	US
Telephone Number	:	702-486-0693
Fax Number	:	702-486-7154

Provider Business Practice Location Address
First Line	:	2008 BLOOMFIELD CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-6229
Country	:	US
Telephone Number	:	714-317-9844
Fax Number	:

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

Provider Enumeration Date	:	09/28/2017
Last Update Date	:	09/28/2017

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Directions to “ THU TRONG NGO PHARMACIST” Practice Location

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