Provider Demographics
NPI:1174290688
Name:NGO, VICTORIA (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:NGO
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5509 SW 9TH AVE APT 1216
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-4192
Mailing Address - Country:US
Mailing Address - Phone:817-271-1477
Mailing Address - Fax:
Practice Address - Street 1:5807 SW 45TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-5291
Practice Address - Country:US
Practice Address - Phone:806-353-7201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69181183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist