Provider Demographics
NPI:1053463653
Name:NGUYEN, CHI LIEU (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CHI
Middle Name:LIEU
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 1:5026 FRUITRIDGE RD STE 3
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95820-5302
Mailing Address - Country:US
Mailing Address - Phone:916-469-9813
Mailing Address - Fax:916-469-9874
Practice Address - Street 1:5026 FRUITRIDGE RD STE 3
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95820-5302
Practice Address - Country:US
Practice Address - Phone:916-469-9813
Practice Address - Fax:916-469-9874
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH469771835G0303X
CA510513336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA502451Medicaid
CAPHA441890OtherMEDI-CAL NUMBER
CA680366467OtherFEDERAL STATE ID