Provider Demographics
NPI:1013216175
Name:NGUYEN, HUONG DIEM-NGOC (RPH)
Entity Type:Individual
Prefix:
First Name:HUONG
Middle Name:DIEM-NGOC
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 1:2775 PORT SHELDON RD
Mailing Address - Street 2:
Mailing Address - City:JENISON
Mailing Address - State:MI
Mailing Address - Zip Code:49428-9359
Mailing Address - Country:US
Mailing Address - Phone:616-669-0970
Mailing Address - Fax:616-662-0411
Practice Address - Street 1:2775 PORT SHELDON RD
Practice Address - Street 2:
Practice Address - City:JENISON
Practice Address - State:MI
Practice Address - Zip Code:49428-9359
Practice Address - Country:US
Practice Address - Phone:616-669-0970
Practice Address - Fax:616-662-0411
Is Sole Proprietor?:No
Enumeration Date:2011-03-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302031453183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist