Provider Demographics
NPI:1548723844
Name:NGUYEN, NGOC THI (RPH)
Entity type:Individual
Prefix:MRS
First Name:NGOC
Middle Name:THI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2407 JENSEN AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:SANGER
Mailing Address - State:CA
Mailing Address - Zip Code:93657-2497
Mailing Address - Country:US
Mailing Address - Phone:559-399-8644
Mailing Address - Fax:559-399-8643
Practice Address - Street 1:2407 JENSEN AVE STE 101
Practice Address - Street 2:
Practice Address - City:SANGER
Practice Address - State:CA
Practice Address - Zip Code:93657-2497
Practice Address - Country:US
Practice Address - Phone:559-399-8644
Practice Address - Fax:559-399-8643
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-12
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH55050183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist