Provider Demographics
NPI:1093471971
Name:NGUYEN, ANTHONY XUAN (PHARM D)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:XUAN
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 ATLANTIC AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-2701
Mailing Address - Country:US
Mailing Address - Phone:562-661-1440
Mailing Address - Fax:562-661-1442
Practice Address - Street 1:2701 ATLANTIC AVE STE 100
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2701
Practice Address - Country:US
Practice Address - Phone:562-661-1440
Practice Address - Fax:562-661-1442
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-15
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55088183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2701690Medicaid