Provider Demographics
NPI:1073118899
Name:NGUYEN, NICHOLAS (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15411 WALLISVILLE RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77049-4613
Mailing Address - Country:US
Mailing Address - Phone:281-459-2740
Mailing Address - Fax:
Practice Address - Street 1:15411 WALLISVILLE RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77049-4613
Practice Address - Country:US
Practice Address - Phone:281-459-2740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67243183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist