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General NPI Number Information
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NPI Number | 1699370577
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Entity Type | Individual
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Provider Name | MY LINH NGO
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Gender | Female
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Dates
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Enumeration Date | 12/01/2020
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Last Update Date | 12/01/2020
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Provider Practice Location Address
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Address Line | 581 FLINT RIVER RD
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City | RIVERDALE
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State | GA
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Zip | 30274-4519
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Country | US
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Telephone | 770-603-2044
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Fax |
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Provider Business Mailing Address
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Address Line | 6188 HILLCREST DR
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City | MORROW
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State | GA
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Zip | 30260-1478
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Country | US
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Telephone | 678-978-6046
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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 | 029698
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License Number State | GA
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