Provider Demographics
NPI:1073249025
Name:NGUYEN, ALI TRINH (PHARMD)
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:TRINH
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 1:3100 DEBORAH DR APT 97
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-2092
Mailing Address - Country:US
Mailing Address - Phone:337-371-0961
Mailing Address - Fax:
Practice Address - Street 1:184 OLD WINNFIELD RD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:LA
Practice Address - Zip Code:71251-5902
Practice Address - Country:US
Practice Address - Phone:318-259-6694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-30
Last Update Date:2022-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.024419183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist