=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689084469
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANH THU NGUYEN NGO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/02/2014
-----------------------------------------------------
Last Update Date | 05/02/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8001 US HIGHWAY 19 N
-----------------------------------------------------
City | PINELLAS PARK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33781-1744
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-578-5020
-----------------------------------------------------
Fax | 727-578-5410
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14016 POMELO PL
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33625-3173
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-808-0424
-----------------------------------------------------
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 | PS39650
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------