Provider Demographics
NPI:1730701392
Name:NGUYEN, ALEXANDER TAM-PHAN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:TAM-PHAN
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:773 N SILVER LEAF LN
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60073-5267
Mailing Address - Country:US
Mailing Address - Phone:847-226-8067
Mailing Address - Fax:
Practice Address - Street 1:773 N SILVER LEAF LN
Practice Address - Street 2:
Practice Address - City:ROUND LAKE
Practice Address - State:IL
Practice Address - Zip Code:60073-5267
Practice Address - Country:US
Practice Address - Phone:847-226-8067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-17
Last Update Date:2020-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0492118431835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist