Provider Demographics
NPI:1750659884
Name:NGO, PHUONG-THUY
Entity Type:Individual
Prefix:
First Name:PHUONG-THUY
Middle Name:
Last Name:NGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12115 SCENIC VIEW TER
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-4100
Mailing Address - Country:US
Mailing Address - Phone:909-874-6700
Mailing Address - Fax:909-874-0680
Practice Address - Street 1:550 S RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-7028
Practice Address - Country:US
Practice Address - Phone:909-874-6700
Practice Address - Fax:909-874-0680
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-03
Last Update Date:2011-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55440183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist