Provider Demographics
NPI:1184047623
Name:NGO, BENJAMIN (RPH)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:
Last Name:NGO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7942 15TH ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-4414
Mailing Address - Country:US
Mailing Address - Phone:714-901-6470
Mailing Address - Fax:760-921-4377
Practice Address - Street 1:7942 15TH ST
Practice Address - Street 2:9315 BOLSA AVE .PMB #118
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-4414
Practice Address - Country:US
Practice Address - Phone:714-901-6470
Practice Address - Fax:760-921-4377
Is Sole Proprietor?:No
Enumeration Date:2014-02-03
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10010183500000X
CA43382183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist