Provider Demographics
NPI:1447613401
Name:NGAN, TAMMY (RPH)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:NGAN
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 1:699 LEWELLING BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94579-1870
Mailing Address - Country:US
Mailing Address - Phone:510-351-0951
Mailing Address - Fax:
Practice Address - Street 1:699 LEWELLING BLVD
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94579-1870
Practice Address - Country:US
Practice Address - Phone:510-351-0951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-29
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA71722183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist