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NPI Code Detail

MEDICARE: VAN NGOC AU

MEDICARE: VAN NGOC AU
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
1183500000XPharmacistRP451867PA

General Provider Information

NPI Number : 1598362345
Entity Type Code : Individual
Provider Name (Legal Business Name) : VAN NGOC AU
Provider Business Mailing Address
First Line : 4042 I ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19124-5202
Country : US
Telephone Number : 215-400-0795
Fax Number :
Provider Business Practice Location Address
First Line : 7720 BUSTLETON AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19152-3818
Country : US
Telephone Number : 215-342-1091
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/05/2020
Last Update Date : 12/26/2020

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Directions to “ VAN NGOC AU ” Practice Location

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