Provider Demographics
NPI:1114699691
Name:NGUYEN, THANH TRUC D
Entity Type:Individual
Prefix:
First Name:THANH TRUC
Middle Name:D
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2514 BERRYESSA RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95132-2947
Mailing Address - Country:US
Mailing Address - Phone:408-272-1431
Mailing Address - Fax:408-926-6142
Practice Address - Street 1:2514 BERRYESSA RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95132-2947
Practice Address - Country:US
Practice Address - Phone:408-272-1431
Practice Address - Fax:408-926-6142
Is Sole Proprietor?:No
Enumeration Date:2021-10-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85065183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist