Provider Demographics
NPI:1942397906
Name:NG, VICTOR YIP (PHARM D)
Entity type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:YIP
Last Name:NG
Suffix:
Gender:M
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 1:2023 VALE ROAD SUITE 101
Mailing Address - Street 2:VALE ROAD PHARMACY
Mailing Address - City:SAN PABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94806-3834
Mailing Address - Country:US
Mailing Address - Phone:510-232-2377
Mailing Address - Fax:
Practice Address - Street 1:2023 VALE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-3834
Practice Address - Country:US
Practice Address - Phone:510-232-2377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-09
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY34652183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA346520Medicaid
CA0579550OtherNABP