Provider Demographics
NPI:1083269815
Name:NGUYEN, KHANG M (PHARMD)
Entity Type:Individual
Prefix:
First Name:KHANG
Middle Name:M
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 CENTERRA PKWY STE 10
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766-1411
Mailing Address - Country:US
Mailing Address - Phone:603-653-3785
Mailing Address - Fax:
Practice Address - Street 1:12 CENTERRA PKWY STE 10
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-1411
Practice Address - Country:US
Practice Address - Phone:603-653-3785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-08
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHPHCY-00879183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist