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General NPI Number Information
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NPI Number | 1649921412
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Entity Type | Individual
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Provider Name | NGON-VINCENT VAN PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 01/13/2022
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Last Update Date | 04/10/2025
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Provider Practice Location Address
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Address Line | 10913 NW 30TH ST STE 102
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City | DORAL
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State | FL
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Zip | 33172-5029
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Country | US
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Telephone | 888-648-1134
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Fax |
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Provider Business Mailing Address
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Address Line | 1901 NE 15TH AVE
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City | FORT LAUDERDALE
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State | FL
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Zip | 33305-3260
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Country | US
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Telephone | 870-656-2420
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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 | PS58844
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License Number State | FL
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