Healthcare Provider Details

I. General information

NPI: 1104329267
Provider Name (Legal Business Name): THANH T NGO PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2018
Last Update Date: 03/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1698 PULASKI HWY
BEAR DE
19701-1452
US

IV. Provider business mailing address

2605 SAINT CHRISTOPHER DR
PHILADELPHIA PA
19148-4701
US

V. Phone/Fax

Practice location:
  • Phone: 302-836-1004
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberA1-0005171
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: