Provider Demographics
NPI:1164031860
Name:NGUYEN, JERIKA (PHARMD, BCPS, BCCCP)
Entity Type:Individual
Prefix:DR
First Name:JERIKA
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PHARMD, BCPS, BCCCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 CLANCY AVE NE APT 120
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-1843
Mailing Address - Country:US
Mailing Address - Phone:616-350-1555
Mailing Address - Fax:
Practice Address - Street 1:525 CLANCY AVE NE APT 120
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-1843
Practice Address - Country:US
Practice Address - Phone:616-350-1555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0016027183500000X
PARP452948183500000X
MI71525641835C0205X
MI31587081835P1200X
MI5302411567183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835C0205XPharmacy Service ProvidersPharmacistCritical Care
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy