MEDICARE: DR. SAMANTHA 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
1	183500000X	Pharmacist	54883	CA

General Provider Information

NPI Number	:	1285713172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMANTHA NGO PHARM.D.

Provider Business Mailing Address
First Line	:	PO BOX 292578
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-7578
Country	:	US
Telephone Number	:	323-783-4014
Fax Number	:	323-783-3131

Provider Business Practice Location Address
First Line	:	4950 SUNSET BLVD
Second Line	:	MEZZANINE LEVEL
City	:	LOS ANGELES
State	:	CA
Zip	:	90027
Country	:	US
Telephone Number	:	323-783-4014
Fax Number	:	323-783-3131

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	07/08/2007

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