Provider Demographics
NPI:1043591811
Name:NGUYEN, TUAN THANH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TUAN
Middle Name:THANH
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 1:4145 30TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-1905
Mailing Address - Country:US
Mailing Address - Phone:619-284-3582
Mailing Address - Fax:619-284-0619
Practice Address - Street 1:4145 30TH ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-1905
Practice Address - Country:US
Practice Address - Phone:619-284-3582
Practice Address - Fax:619-284-0619
Is Sole Proprietor?:No
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65514183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist