Provider Demographics
NPI:1083016778
Name:NGUYEN, YEN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:YEN
Middle Name:
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 1:11228 OLD 63 S
Mailing Address - Street 2:
Mailing Address - City:LUCEDALE
Mailing Address - State:MS
Mailing Address - Zip Code:39452-4945
Mailing Address - Country:US
Mailing Address - Phone:601-947-4287
Mailing Address - Fax:601-947-6152
Practice Address - Street 1:11228 OLD 63 S
Practice Address - Street 2:
Practice Address - City:LUCEDALE
Practice Address - State:MS
Practice Address - Zip Code:39452-4945
Practice Address - Country:US
Practice Address - Phone:601-947-4287
Practice Address - Fax:601-947-6152
Is Sole Proprietor?:No
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE12311183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist