Provider Demographics
NPI:1316535875
Name:NGOC, GARY QUANG (PHARMD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:QUANG
Last Name:NGOC
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5688 TELEPHONE RD
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-5326
Mailing Address - Country:US
Mailing Address - Phone:805-644-5922
Mailing Address - Fax:
Practice Address - Street 1:5688 TELEPHONE RD
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-5326
Practice Address - Country:US
Practice Address - Phone:805-644-5922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-08
Last Update Date:2023-07-17
Deactivation Date:2022-08-27
Deactivation Code:
Reactivation Date:2022-09-20
Provider Licenses
StateLicense IDTaxonomies
CAINT43686390200000X
CA86627183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program