Healthcare Provider Details

I. General information

NPI: 1528577988
Provider Name (Legal Business Name): THU TRONG NGO PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2017
Last Update Date: 09/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2008 BLOOMFIELD CT
LAS VEGAS NV
89134-6229
US

IV. Provider business mailing address

1650 COMMUNITY COLLEGE DR
LAS VEGAS NV
89146-1144
US

V. Phone/Fax

Practice location:
  • Phone: 714-317-9844
  • Fax:
Mailing address:
  • Phone: 702-486-0693
  • Fax: 702-486-7154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number14421
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14421
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: