Provider Demographics
NPI:1821439027
Name:NGO, NHAN LE THANH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NHAN
Middle Name:LE THANH
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 1:7365 ROCK CANYON DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-1063
Mailing Address - Country:US
Mailing Address - Phone:251-786-1047
Mailing Address - Fax:
Practice Address - Street 1:5504 BALBOA AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-2704
Practice Address - Country:US
Practice Address - Phone:858-495-9155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA68443183500000X
AL17086183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist