Provider Demographics
NPI:1942850425
Name:VAN, NGHI
Entity Type:Individual
Prefix:
First Name:NGHI
Middle Name:
Last Name:VAN
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 1:4200 BUCKINGHAM RD STE 105B
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76155-2618
Mailing Address - Country:US
Mailing Address - Phone:844-387-9090
Mailing Address - Fax:
Practice Address - Street 1:4200 BUCKINGHAM RD STE 105B
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76155-2618
Practice Address - Country:US
Practice Address - Phone:844-387-9090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-16
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41027183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist