Provider Demographics
NPI:1619259637
Name:NGO, SALLY D (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SALLY
Middle Name:D
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 1:6480 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUDSONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49426-8800
Mailing Address - Country:US
Mailing Address - Phone:616-669-8518
Mailing Address - Fax:616-669-4869
Practice Address - Street 1:6480 28TH AVE
Practice Address - Street 2:
Practice Address - City:HUDSONVILLE
Practice Address - State:MI
Practice Address - Zip Code:49426-8800
Practice Address - Country:US
Practice Address - Phone:616-669-8518
Practice Address - Fax:616-669-4869
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302036113183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302036113OtherSTATE OF MICHIGAN-BOARD OF PHARMACY