Provider Demographics
NPI:1083273726
Name:NGUYEN, LAN H (PHARMACIST)
Entity Type:Individual
Prefix:MS
First Name:LAN
Middle Name:H
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 FAIRMONT DR
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-3507
Mailing Address - Country:US
Mailing Address - Phone:510-276-8106
Mailing Address - Fax:510-276-6846
Practice Address - Street 1:1300 FAIRMONT DR
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-3507
Practice Address - Country:US
Practice Address - Phone:510-276-8106
Practice Address - Fax:510-276-6846
Is Sole Proprietor?:No
Enumeration Date:2019-06-06
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52819183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist