Healthcare Provider Details

I. General information

NPI: 1801127063
Provider Name (Legal Business Name): NGOC LUONG PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY LUONG PHARMD

II. Dates (important events)

Enumeration Date: 01/27/2010
Last Update Date: 01/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8911 N 7TH ST
PHOENIX AZ
85020-2911
US

IV. Provider business mailing address

8911 N 7TH ST
PHOENIX AZ
85020-2911
US

V. Phone/Fax

Practice location:
  • Phone: 602-944-9635
  • Fax:
Mailing address:
  • Phone: 602-944-9635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15666
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: