Provider Demographics
NPI:1336512227
Name:LA, NGOC MY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NGOC
Middle Name:MY
Last Name:LA
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 1:18450 LOMOND WAY
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94552-1826
Mailing Address - Country:US
Mailing Address - Phone:510-368-0246
Mailing Address - Fax:
Practice Address - Street 1:699 LEWELLING BLVD
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94579-1870
Practice Address - Country:US
Practice Address - Phone:510-351-0951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-02
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64939183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist