Provider Demographics
NPI:1083904346
Name:NGUYEN, TAM THANH (RPH)
Entity Type:Individual
Prefix:MR
First Name:TAM
Middle Name:THANH
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 W LEE HWY
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186-2093
Mailing Address - Country:US
Mailing Address - Phone:540-347-3020
Mailing Address - Fax:540-347-5329
Practice Address - Street 1:251 W LEE HWY
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-2093
Practice Address - Country:US
Practice Address - Phone:540-347-3020
Practice Address - Fax:540-347-5329
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202204131183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist