Provider Demographics
NPI:1376146480
Name:NGO, TAM NGOC (PHARMD)
Entity Type:Individual
Prefix:
First Name:TAM
Middle Name:NGOC
Last Name:NGO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3555 13TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-4054
Mailing Address - Country:US
Mailing Address - Phone:407-892-7161
Mailing Address - Fax:407-892-5184
Practice Address - Street 1:3555 13TH ST
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-4054
Practice Address - Country:US
Practice Address - Phone:407-892-7161
Practice Address - Fax:407-892-5184
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS40853183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist