Provider Demographics
NPI:1275849945
Name:NGO, THANH-TRUC (RPH)
Entity Type:Individual
Prefix:
First Name:THANH-TRUC
Middle Name:
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 1:14121 RAMONA BLVD
Mailing Address - Street 2:
Mailing Address - City:BALDWIN PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91706-3146
Mailing Address - Country:US
Mailing Address - Phone:626-337-0540
Mailing Address - Fax:626-337-8302
Practice Address - Street 1:14121 RAMONA BLVD
Practice Address - Street 2:
Practice Address - City:BALDWIN PARK
Practice Address - State:CA
Practice Address - Zip Code:91706-3146
Practice Address - Country:US
Practice Address - Phone:626-337-0540
Practice Address - Fax:626-337-8302
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46454183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist