Provider Demographics
NPI:1003417122
Name:NGUYEN, THU TRANG THI (RPH)
Entity Type:Individual
Prefix:
First Name:THU TRANG
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 1:2706 ELSMORE ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-1409
Mailing Address - Country:US
Mailing Address - Phone:703-727-0909
Mailing Address - Fax:
Practice Address - Street 1:8941 OX RD
Practice Address - Street 2:
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079-3218
Practice Address - Country:US
Practice Address - Phone:703-690-5001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26878183500000X
DCPH100003854183500000X
VA0202218190183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty