MEDICARE: MR. CHI WING NG R. PH

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	PS29906	FL

General Provider Information

NPI Number	:	1609094200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHI WING NG R. PH

Provider Business Mailing Address
First Line	:	2056 WESTBOURNE DR
Second Line	:
City	:	OVIEDO
State	:	FL
Zip	:	32765-5155
Country	:	US
Telephone Number	:	407-384-7116
Fax Number	:	407-384-5649

Provider Business Practice Location Address
First Line	:	12500 LAKE UNDERHILL RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-7100
Country	:	US
Telephone Number	:	407-384-7116
Fax Number	:	407-384-5649

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

Provider Enumeration Date	:	04/22/2007
Last Update Date	:	07/08/2007

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