Provider Demographics
NPI:1861898074
Name:NGUYEN, QUAN (PHARMACIST)
Entity type:Individual
Prefix:
First Name:QUAN
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10138 GARVEY AVE
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91733-5012
Mailing Address - Country:US
Mailing Address - Phone:626-442-6611
Mailing Address - Fax:626-442-2066
Practice Address - Street 1:10138 GARVEY AVE
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91733-5012
Practice Address - Country:US
Practice Address - Phone:626-442-6611
Practice Address - Fax:626-442-2066
Is Sole Proprietor?:No
Enumeration Date:2014-11-15
Last Update Date:2014-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 45124183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist