Provider Demographics
NPI:1124547856
Name:NGUYEN, LINH BAO (PHARMD)
Entity Type:Individual
Prefix:
First Name:LINH
Middle Name:BAO
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4469 WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3807
Mailing Address - Country:US
Mailing Address - Phone:706-854-1516
Mailing Address - Fax:706-854-1507
Practice Address - Street 1:4469 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3807
Practice Address - Country:US
Practice Address - Phone:706-854-1516
Practice Address - Fax:706-854-1507
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-13
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH030022183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist