Provider Demographics
NPI:1063017846
Name:NGUYEN, MAI-HUONG THANH (PHARMD)
Entity Type:Individual
Prefix:
First Name:MAI-HUONG
Middle Name:THANH
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 1:3502 EDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-2924
Mailing Address - Country:US
Mailing Address - Phone:407-245-1001
Mailing Address - Fax:407-245-1006
Practice Address - Street 1:3502 EDGEWATER DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-2924
Practice Address - Country:US
Practice Address - Phone:407-245-1001
Practice Address - Fax:407-245-1006
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS44881183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist