Provider Demographics
NPI:1144986340
Name:NGUYEN, KIET (PHARMACIST)
Entity type:Individual
Prefix:
First Name:KIET
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 S SOONER RD STE B
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73135-5601
Mailing Address - Country:US
Mailing Address - Phone:405-543-2680
Mailing Address - Fax:405-543-2687
Practice Address - Street 1:6001 S SOONER RD STE B
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73135-5601
Practice Address - Country:US
Practice Address - Phone:405-543-2680
Practice Address - Fax:405-543-2687
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-11
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK843875621Medicaid