Provider Demographics
NPI:1033720875
Name:NGUYEN, JOEY MARK (PHARMD)
Entity Type:Individual
Prefix:
First Name:JOEY
Middle Name:MARK
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 1:747 GALLIVAN BLVD
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02122
Mailing Address - Country:US
Mailing Address - Phone:617-282-5246
Mailing Address - Fax:617-288-5242
Practice Address - Street 1:747 GALLIVAN BLVD
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02122
Practice Address - Country:US
Practice Address - Phone:617-282-5246
Practice Address - Fax:617-288-5242
Is Sole Proprietor?:No
Enumeration Date:2020-08-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79987183500000X
TX59686183500000X
MAP-MA-CV19-718684183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist