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NPI Code Detail

MEDICARE: MRS. JEANNIE M NGO PHARM.D

MEDICARE: MRS. JEANNIE M NGO PHARM.D
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist55756CA

General Provider Information

NPI Number : 1205134558
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JEANNIE M NGO PHARM.D
Provider Business Mailing Address
First Line : 1900 DAVIS ST
Second Line :
City : SAN LEANDRO
State : CA
Zip : 94577-1209
Country : US
Telephone Number : 510-821-2274
Fax Number :
Provider Business Practice Location Address
First Line : 1900 DAVIS ST
Second Line :
City : SAN LEANDRO
State : CA
Zip : 94577-1209
Country : US
Telephone Number : 510-821-2274
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/10/2011
Last Update Date : 03/10/2011

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