Provider Demographics
NPI:1053663849
Name:NGUYEN, DUNG
Entity Type:Individual
Prefix:
First Name:DUNG
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26852 HIGHWAY 23
Mailing Address - Street 2:
Mailing Address - City:PORT SULPHUR
Mailing Address - State:LA
Mailing Address - Zip Code:70083-2508
Mailing Address - Country:US
Mailing Address - Phone:504-715-2197
Mailing Address - Fax:
Practice Address - Street 1:26852 HIGHWAY 23
Practice Address - Street 2:
Practice Address - City:PORT SULPHUR
Practice Address - State:LA
Practice Address - Zip Code:70083-2508
Practice Address - Country:US
Practice Address - Phone:504-715-2197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA019472183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist