Provider Demographics
NPI:1720321953
Name:DYSTER, NGOCCAM AMY (PHARM D)
Entity Type:Individual
Prefix:
First Name:NGOCCAM
Middle Name:AMY
Last Name:DYSTER
Suffix:
Gender:F
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 1:8055 SHERIDAN BLVD
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80003-1910
Mailing Address - Country:US
Mailing Address - Phone:303-487-5325
Mailing Address - Fax:
Practice Address - Street 1:8055 SHERIDAN BLVD
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80003-1910
Practice Address - Country:US
Practice Address - Phone:303-487-5325
Practice Address - Fax:303-487-5326
Is Sole Proprietor?:No
Enumeration Date:2013-04-06
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15919183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist