Provider Demographics
NPI:1003137175
Name:NGO, PHUONG LIEN (RPH)
Entity Type:Individual
Prefix:
First Name:PHUONG
Middle Name:LIEN
Last Name:NGO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4236 LA RICA AVE # A
Mailing Address - Street 2:
Mailing Address - City:BALDWIN PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91706-3135
Mailing Address - Country:US
Mailing Address - Phone:626-337-0699
Mailing Address - Fax:
Practice Address - Street 1:69 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-3514
Practice Address - Country:US
Practice Address - Phone:626-300-8049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-11
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58026183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist