Provider Demographics
NPI:1639527617
Name:NGO, ANITA KY (PHARM D)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:KY
Last Name:NGO
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:ANITA
Other - Middle Name:KY
Other - Last Name:NGO-PETERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARM D
Mailing Address - Street 1:3433 LAKE JOHANNA BLVD
Mailing Address - Street 2:
Mailing Address - City:ARDEN HILLS
Mailing Address - State:MN
Mailing Address - Zip Code:55112-7935
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8441 WAYZATA BLVD STE 340
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55426-1372
Practice Address - Country:US
Practice Address - Phone:952-542-5515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-31
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN122004183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist