Provider Demographics
NPI:1043761737
Name:NGUYEN, JACKIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:JACKIE
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 7TH ST
Mailing Address - Street 2:WALMART PHARMACY
Mailing Address - City:BAY CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77414-8743
Mailing Address - Country:US
Mailing Address - Phone:979-245-0095
Mailing Address - Fax:
Practice Address - Street 1:4600 7TH ST
Practice Address - Street 2:WALMART PHARMACY
Practice Address - City:BAY CITY
Practice Address - State:TX
Practice Address - Zip Code:77414-8743
Practice Address - Country:US
Practice Address - Phone:979-245-0095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX49605183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX49605OtherTEXAS BOARD OF PHARMACY