Provider Demographics
NPI:1326462961
Name:NGUYEN, MAI T (PHARMD)
Entity type:Individual
Prefix:
First Name:MAI
Middle Name:T
Last Name:NGUYEN
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 1:3700 FETTLER PARK DR
Mailing Address - Street 2:
Mailing Address - City:DUMFRIES
Mailing Address - State:VA
Mailing Address - Zip Code:22025-2050
Mailing Address - Country:US
Mailing Address - Phone:703-441-7509
Mailing Address - Fax:703-441-7692
Practice Address - Street 1:3700 FETTLER PARK DR
Practice Address - Street 2:
Practice Address - City:DUMFRIES
Practice Address - State:VA
Practice Address - Zip Code:22025-2050
Practice Address - Country:US
Practice Address - Phone:703-441-7509
Practice Address - Fax:703-441-7692
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202206335183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist