Provider Demographics
NPI:1124011382
Name:NGUYEN, NGHIA TRONG (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:NGHIA
Middle Name:TRONG
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 1:205 ALICE FARR DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29617-1505
Mailing Address - Country:US
Mailing Address - Phone:864-921-1240
Mailing Address - Fax:
Practice Address - Street 1:200 N HIGHWAY 25
Practice Address - Street 2:
Practice Address - City:TRAVELERS REST
Practice Address - State:SC
Practice Address - Zip Code:29690-2300
Practice Address - Country:US
Practice Address - Phone:864-834-7762
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO16869183500000X
SC011047183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist