Provider Demographics
NPI:1770866469
Name:BACH, HONG NGOC (PHARMD)
Entity Type:Individual
Prefix:
First Name:HONG NGOC
Middle Name:
Last Name:BACH
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 1:2441 BELVEDERE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-6510
Mailing Address - Country:US
Mailing Address - Phone:510-895-9489
Mailing Address - Fax:
Practice Address - Street 1:11565 SAN PABLO AVE
Practice Address - Street 2:
Practice Address - City:EL CERRITO
Practice Address - State:CA
Practice Address - Zip Code:94530-1951
Practice Address - Country:US
Practice Address - Phone:510-234-9300
Practice Address - Fax:510-234-8986
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57803183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist