Provider Demographics
NPI:1003406646
Name:NGO, NGUYET-MINH TRAN (RPH)
Entity Type:Individual
Prefix:
First Name:NGUYET-MINH
Middle Name:TRAN
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 1:22832 US HIGHWAY 281 N
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-7430
Mailing Address - Country:US
Mailing Address - Phone:210-679-2369
Mailing Address - Fax:
Practice Address - Street 1:22832 US HIGHWAY 281 N
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-7430
Practice Address - Country:US
Practice Address - Phone:210-679-2369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX58121183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX58121OtherTEXAS LICENSE
FLPS54820OtherFL LICENSE