=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508358268
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANGELA SY NGO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/30/2018
-----------------------------------------------------
Last Update Date | 08/21/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1880 E IRVINGTON RD
-----------------------------------------------------
City | TUCSON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85714
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-294-1975
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3300 N PASEO DE LOS RIOS APT 4204
-----------------------------------------------------
City | TUCSON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85712-6058
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-836-0590
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | S023512
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------