Provider Demographics
NPI:1912270778
Name:NGO, THIEN THAO THI (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:THIEN THAO
Middle Name:THI
Last Name:NGO
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 1:1309 FULTON AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-3603
Mailing Address - Country:US
Mailing Address - Phone:916-483-3486
Mailing Address - Fax:916-483-9723
Practice Address - Street 1:1309 FULTON AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-3603
Practice Address - Country:US
Practice Address - Phone:916-483-3486
Practice Address - Fax:916-483-9723
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65683183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA65683OtherCALIFORNIA PHAMACIST LICENSE