Provider Demographics
NPI:1922665645
Name:NGO, CHRISTIAN QUOC (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:QUOC
Last Name:NGO
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5630 COTTLE RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123
Mailing Address - Country:US
Mailing Address - Phone:408-600-3722
Mailing Address - Fax:
Practice Address - Street 1:5630 COTTLE RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-3696
Practice Address - Country:US
Practice Address - Phone:408-600-3722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA69060183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1053733121OtherSTORE NPI