Healthcare Provider Details

I. General information

NPI: 1609354455
Provider Name (Legal Business Name): MARIA NGO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2018
Last Update Date: 09/10/2020
Certification Date: 09/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12332 MANCHESTER RD
SAINT LOUIS MO
63131-4315
US

IV. Provider business mailing address

2748 HILDA CT
ORLANDO FL
32826-3841
US

V. Phone/Fax

Practice location:
  • Phone: 314-965-0062
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2020017118
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.303338
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS57988
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: