Provider Demographics
NPI:1730476508
Name:NGUYEN, MARY L I (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:L
Last Name:NGUYEN
Suffix:I
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 1:751 ALTA MERE DR
Mailing Address - Street 2:T-2425
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-1526
Mailing Address - Country:US
Mailing Address - Phone:817-566-0566
Mailing Address - Fax:817-566-0576
Practice Address - Street 1:751 ALTA MERE DR
Practice Address - Street 2:T-2425
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-1526
Practice Address - Country:US
Practice Address - Phone:817-566-0566
Practice Address - Fax:817-566-0576
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-30
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41047183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist