Provider Demographics
NPI:1023545779
Name:NGUYEN, DUSTIN TRONG (PHARMD)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:TRONG
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 1:3901 W. EL RANCHO AVE
Mailing Address - Street 2:APT. C
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868
Mailing Address - Country:US
Mailing Address - Phone:714-654-1178
Mailing Address - Fax:
Practice Address - Street 1:5555 GROSSMONT CENTER DRIVE
Practice Address - Street 2:A217
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942
Practice Address - Country:US
Practice Address - Phone:619-740-4451
Practice Address - Fax:619-740-4354
Is Sole Proprietor?:No
Enumeration Date:2017-05-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA68718183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist