Provider Demographics
NPI:1467051334
Name:NGO, BRIAN ZACHARY (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:ZACHARY
Last Name:NGO
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 1:1561 HUDSON ST
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94061-2927
Mailing Address - Country:US
Mailing Address - Phone:650-465-8800
Mailing Address - Fax:
Practice Address - Street 1:1561 HUDSON ST
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94061-2927
Practice Address - Country:US
Practice Address - Phone:650-465-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83314183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist