Provider Demographics
NPI:1093075178
Name:NGUYEN, DIEM PHUONG (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:DIEM
Middle Name:PHUONG
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 1:6404 ALBEMARLE RD STE I
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-3801
Mailing Address - Country:US
Mailing Address - Phone:704-531-8881
Mailing Address - Fax:704-531-5889
Practice Address - Street 1:6404 ALBEMARLE RD STE I
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-3801
Practice Address - Country:US
Practice Address - Phone:704-531-8881
Practice Address - Fax:704-531-5889
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-22
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15610183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist