Provider Demographics
NPI:1538440540
Name:NGUYEN, MINH TAM
Entity type:Individual
Prefix:
First Name:MINH TAM
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12818 DOVE POINT LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77041-4256
Mailing Address - Country:US
Mailing Address - Phone:504-858-5733
Mailing Address - Fax:
Practice Address - Street 1:2700 JOHNSTON ST
Practice Address - Street 2:WALGREENS
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-3242
Practice Address - Country:US
Practice Address - Phone:504-858-5733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-03
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.019630183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist