Healthcare Provider Details

I. General information

NPI: 1487355491
Provider Name (Legal Business Name): TALIA WYLIE NGO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2023
Last Update Date: 03/15/2023
Certification Date: 03/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 SCHRADER BLVD
LOS ANGELES CA
90028-6213
US

IV. Provider business mailing address

1619 S MARENGO AVE
ALHAMBRA CA
91803-3006
US

V. Phone/Fax

Practice location:
  • Phone: 323-993-7513
  • Fax:
Mailing address:
  • Phone: 626-329-3141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH77452
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: