Provider Demographics
NPI:1093254534
Name:NGUYEN, AILIEN THI (PHARMACIST)
Entity Type:Individual
Prefix:MRS
First Name:AILIEN
Middle Name:THI
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 1:601 S CARR RD STE 100
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5802
Mailing Address - Country:US
Mailing Address - Phone:425-227-3122
Mailing Address - Fax:425-227-3772
Practice Address - Street 1:601 S CARR RD STE 100
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5802
Practice Address - Country:US
Practice Address - Phone:425-227-3122
Practice Address - Fax:425-227-3772
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-16
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH 00013739183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist