Provider Demographics
NPI:1083295950
Name:NGUYEN, SON QUOC (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:SON
Middle Name:QUOC
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 CORTARO DR
Mailing Address - Street 2:
Mailing Address - City:SUN CITY CENTER
Mailing Address - State:FL
Mailing Address - Zip Code:33573-6812
Mailing Address - Country:US
Mailing Address - Phone:813-551-2999
Mailing Address - Fax:813-922-4155
Practice Address - Street 1:765 CORTARO DR
Practice Address - Street 2:
Practice Address - City:SUN CITY CENTER
Practice Address - State:FL
Practice Address - Zip Code:33573-6812
Practice Address - Country:US
Practice Address - Phone:813-551-2999
Practice Address - Fax:813-922-4155
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS557521835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care