MEDICARE: DR. ANH T NGO RPH

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	RPH79764	CA

General Provider Information

NPI Number	:	1316580376
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANH T NGO RPH

Provider Business Mailing Address
First Line	:	2187 LAKE TAHOE BLVD APT 15
Second Line	:
City	:	SOUTH LAKE TAHOE
State	:	CA
Zip	:	96150-6465
Country	:	US
Telephone Number	:	310-947-4912
Fax Number	:

Provider Business Practice Location Address
First Line	:	1043 EMERALD BAY RD
Second Line	:
City	:	SOUTH LAKE TAHOE
State	:	CA
Zip	:	96150-6210
Country	:	US
Telephone Number	:	916-297-2040
Fax Number	:

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

Provider Enumeration Date	:	10/22/2019
Last Update Date	:	10/22/2019

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