Provider Demographics
NPI:1538854203
Name:NGUYEN, KRISTINE HOANG (PHARMD)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:HOANG
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 1:9612 SKYLARK BLVD
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92841-2632
Mailing Address - Country:US
Mailing Address - Phone:714-307-9388
Mailing Address - Fax:
Practice Address - Street 1:9612 SKYLARK BLVD
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92841-2632
Practice Address - Country:US
Practice Address - Phone:714-307-9388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87684183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist