Healthcare Provider Details

I. General information

NPI: 1134386824
Provider Name (Legal Business Name): LAN K NGO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 09/16/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VA NORTHERN INDIANA HEALTH CARE SYSTEM - MARION 1700 EAST 38TH ST
MARION IN
46953-4568
US

IV. Provider business mailing address

12202 EDDINGTON PL
FISHERS IN
46037-5404
US

V. Phone/Fax

Practice location:
  • Phone: 765-674-3321
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number29413
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: