Healthcare Provider Details

I. General information

NPI: 1588118640
Provider Name (Legal Business Name): THANH NGO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2016
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2575 W GOLF RD
HOFFMAN ESTATES IL
60169-1165
US

IV. Provider business mailing address

2575 W GOLF RD
HOFFMAN ESTATES IL
60169-1165
US

V. Phone/Fax

Practice location:
  • Phone: 847-490-2047
  • Fax: 847-490-2108
Mailing address:
  • Phone: 847-490-2047
  • Fax: 847-490-2108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number051299695
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: