Provider Demographics
NPI:1043352511
Name:GANGOO, TRICIA A (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TRICIA
Middle Name:A
Last Name:GANGOO
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 1:6950 NW 28TH ST
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-2051
Mailing Address - Country:US
Mailing Address - Phone:954-593-4038
Mailing Address - Fax:954-739-3680
Practice Address - Street 1:3116 W COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-3415
Practice Address - Country:US
Practice Address - Phone:954-739-2829
Practice Address - Fax:954-739-3680
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS29380183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS29380OtherSTATE LICENSE #