Provider Demographics
NPI:1235591934
Name:CHHAY, NGOC
Entity Type:Individual
Prefix:
First Name:NGOC
Middle Name:
Last Name:CHHAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 W BOYLSTON ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-1228
Mailing Address - Country:US
Mailing Address - Phone:508-852-5344
Mailing Address - Fax:508-852-6376
Practice Address - Street 1:14 W BOYLSTON ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-1228
Practice Address - Country:US
Practice Address - Phone:508-852-5344
Practice Address - Fax:508-852-6376
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH27745183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist