Provider Demographics
NPI:1548448723
Name:NGUYEN, GWEN HUYEN
Entity type:Individual
Prefix:
First Name:GWEN
Middle Name:HUYEN
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1704 CARRS MILL CT
Mailing Address - Street 2:
Mailing Address - City:FALLSTON
Mailing Address - State:MD
Mailing Address - Zip Code:21047-1850
Mailing Address - Country:US
Mailing Address - Phone:410-638-2432
Mailing Address - Fax:410-420-2608
Practice Address - Street 1:1704 CARRS MILL CT
Practice Address - Street 2:
Practice Address - City:FALLSTON
Practice Address - State:MD
Practice Address - Zip Code:21047-1850
Practice Address - Country:US
Practice Address - Phone:410-638-2432
Practice Address - Fax:410-420-2608
Is Sole Proprietor?:No
Enumeration Date:2008-02-10
Last Update Date:2008-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15612183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD15612OtherNPI