Provider Demographics
NPI:1124622311
Name:NGO, TRACY (PHARMD)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
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 1:15 BOONTON TPKE
Mailing Address - Street 2:
Mailing Address - City:LINCOLN PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07035-1761
Mailing Address - Country:US
Mailing Address - Phone:973-628-2002
Mailing Address - Fax:973-628-2008
Practice Address - Street 1:15 BOONTON TPKE
Practice Address - Street 2:
Practice Address - City:LINCOLN PARK
Practice Address - State:NJ
Practice Address - Zip Code:07035-1761
Practice Address - Country:US
Practice Address - Phone:973-628-2002
Practice Address - Fax:973-628-2008
Is Sole Proprietor?:No
Enumeration Date:2020-11-28
Last Update Date:2020-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03638900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist