Provider Demographics
NPI:1730955451
Name:NGUYEN, MERCEDES MAI PHUONG
Entity type:Individual
Prefix:
First Name:MERCEDES
Middle Name:MAI PHUONG
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 1:2300 EDENBORN AVE APT 3-178
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-1837
Mailing Address - Country:US
Mailing Address - Phone:228-233-0393
Mailing Address - Fax:
Practice Address - Street 1:4327 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:LA
Practice Address - Zip Code:70121-1519
Practice Address - Country:US
Practice Address - Phone:504-731-1431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.025013183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist