Provider Demographics
NPI:1164794962
Name:NGUYEN, JACQUELINE M (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:M
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 AVENIDA ACASO
Mailing Address - Street 2:SUITE A
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-8749
Mailing Address - Country:US
Mailing Address - Phone:805-388-9336
Mailing Address - Fax:805-482-6324
Practice Address - Street 1:900 AVENIDA ACASO
Practice Address - Street 2:SUITE A
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-8749
Practice Address - Country:US
Practice Address - Phone:805-388-9336
Practice Address - Fax:805-482-6324
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH60668183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist