Provider Demographics
NPI:1164909719
Name:NGUYEN, CAOTHANH (PHARMD)
Entity Type:Individual
Prefix:
First Name:CAOTHANH
Middle Name:
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 1:11307 CHIMNEY ROCK RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77035-2901
Mailing Address - Country:US
Mailing Address - Phone:832-643-3554
Mailing Address - Fax:
Practice Address - Street 1:5002 BELLAIRE BLVD
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-4002
Practice Address - Country:US
Practice Address - Phone:832-643-3554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-26
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1164909719Medicaid