Provider Demographics
NPI:1063003655
Name:NGUYEN, ANTHONY MINH
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:MINH
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8945 ADOBE CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-5735
Mailing Address - Country:US
Mailing Address - Phone:916-230-6659
Mailing Address - Fax:
Practice Address - Street 1:8945 ADOBE CREEK WAY
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-5735
Practice Address - Country:US
Practice Address - Phone:916-230-6659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83886183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist