Provider Demographics
NPI:1558733022
Name:NGO, UYKOK (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:UYKOK
Middle Name:
Last Name:NGO
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:
Other - Last Name:NGO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:29345 EDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-1119
Mailing Address - Country:US
Mailing Address - Phone:949-878-6533
Mailing Address - Fax:
Practice Address - Street 1:CORNER OF ROUTE N12 & N7
Practice Address - Street 2:
Practice Address - City:FORT DEFIANCE
Practice Address - State:AZ
Practice Address - Zip Code:86504
Practice Address - Country:US
Practice Address - Phone:928-729-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-23
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0014902183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist