Provider Demographics
NPI:1790237105
Name:VO, FREDERICK PHAT NGOC (PHARMD)
Entity Type:Individual
Prefix:
First Name:FREDERICK PHAT
Middle Name:NGOC
Last Name:VO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2236 PARK PLACE CIR
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-3905
Mailing Address - Country:US
Mailing Address - Phone:214-790-6156
Mailing Address - Fax:
Practice Address - Street 1:2236 PARK PLACE CIR
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-3905
Practice Address - Country:US
Practice Address - Phone:214-790-6156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-01
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX47037183500000X
AZ13772183500000X
OR0011030183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist