Provider Demographics
NPI:1902351885
Name:NGUYEN, CASEY DAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:DAN
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1849 S POWER RD
Mailing Address - Street 2:#1197
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4332
Mailing Address - Country:US
Mailing Address - Phone:480-204-6608
Mailing Address - Fax:
Practice Address - Street 1:55 W APACHE TRL
Practice Address - Street 2:
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85120-3412
Practice Address - Country:US
Practice Address - Phone:602-732-3384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-19
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS022093183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist