Healthcare Provider Details

I. General information

NPI: 1790293389
Provider Name (Legal Business Name): NGA THIEN HO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2018
Last Update Date: 01/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 GILMAN ST
BERKELEY CA
94710
US

IV. Provider business mailing address

608 SAN GABRIEL AVE APT F
ALBANY CA
94706-1468
US

V. Phone/Fax

Practice location:
  • Phone: 510-528-8274
  • Fax:
Mailing address:
  • Phone: 408-480-0405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number77948
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: