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General NPI Number Information
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NPI Number | 1164740643
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Entity Type | Individual
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Provider Name | SEAN LEAN NGO RPH
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Gender | Male
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Dates
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Enumeration Date | 05/09/2010
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Last Update Date | 05/09/2010
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Provider Practice Location Address
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Address Line | 2 S BLACK HORSE PIKE
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City | BLACKWOOD
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State | NJ
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Zip | 08012-2951
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Country | US
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Telephone | 856-374-4602
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Fax |
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Provider Business Mailing Address
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Address Line | 7 ANNETTE CT
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City | SEWELL
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State | NJ
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Zip | 08080-9334
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Country | US
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Telephone | 856-589-6473
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 28RI02932100
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RP040224L
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License Number State | PA
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