Provider Demographics
NPI:1033394853
Name:NGUYEN, BICHTRAM THI (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:BICHTRAM
Middle Name:THI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5810 187TH ST
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-2229
Mailing Address - Country:US
Mailing Address - Phone:718-357-8945
Mailing Address - Fax:718-357-8945
Practice Address - Street 1:9514 63RD AVE
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374
Practice Address - Country:US
Practice Address - Phone:718-896-5084
Practice Address - Fax:718-896-1898
Is Sole Proprietor?:No
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047334183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0156245Medicaid