=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801249644
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHU YING NG PHARM.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/17/2016
-----------------------------------------------------
Last Update Date | 08/14/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1852 N MASTICK WAY
-----------------------------------------------------
City | NOGALES
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85621-1063
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-761-2128
-----------------------------------------------------
Fax | 520-281-1112
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 825 N GRAND AVE STE 100
-----------------------------------------------------
City | NOGALES
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85621-1061
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-761-2128
-----------------------------------------------------
Fax | 520-281-1112
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1835P2201X
-----------------------------------------------------
Taxonomy Name | Ambulatory Care Pharmacist
-----------------------------------------------------
License Number | 122903
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1835P0018X
-----------------------------------------------------
Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
-----------------------------------------------------
License Number | S027030
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------