Provider Demographics
NPI:1568288819
Name:NGO, MINDY TRUC (RPH)
Entity type:Individual
Prefix:DR
First Name:MINDY
Middle Name:TRUC
Last Name:NGO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16109 SE 59TH ST
Mailing Address - Street 2:
Mailing Address - City:CHOCTAW
Mailing Address - State:OK
Mailing Address - Zip Code:73020-5404
Mailing Address - Country:US
Mailing Address - Phone:405-204-4106
Mailing Address - Fax:
Practice Address - Street 1:14185 MACK HARRINGTON DR
Practice Address - Street 2:
Practice Address - City:CHOCTAW
Practice Address - State:OK
Practice Address - Zip Code:73020-2035
Practice Address - Country:US
Practice Address - Phone:405-390-4495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20741183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist