Provider Demographics
NPI:1083037774
Name:NGUYEN, HUY PHUNG (PHARMD)
Entity Type:Individual
Prefix:
First Name:HUY
Middle Name:PHUNG
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:LANCE
Other - Middle Name:
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:9302 BLANCHE AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92841-3410
Mailing Address - Country:US
Mailing Address - Phone:562-598-2734
Mailing Address - Fax:562-799-1390
Practice Address - Street 1:12470 SEAL BEACH BLVD
Practice Address - Street 2:
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-2711
Practice Address - Country:US
Practice Address - Phone:562-598-2734
Practice Address - Fax:562-799-1390
Is Sole Proprietor?:No
Enumeration Date:2014-01-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61767183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist