Provider Demographics
NPI:1033406194
Name:NGUYEN, LAN (PHARM D)
Entity Type:Individual
Prefix:
First Name:LAN
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 PRECINCT LINE RD
Mailing Address - Street 2:T1766
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053-3828
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1400 PRECINCT LINE RD
Practice Address - Street 2:T1766
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76053-3828
Practice Address - Country:US
Practice Address - Phone:817-282-8917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36974183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist