Provider Demographics
NPI:1194009712
Name:NGUYEN, STACEY P (PHARM D)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:P
Last Name:NGUYEN
Suffix:
Gender:F
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 1:646 S HARBOR BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-1384
Mailing Address - Country:US
Mailing Address - Phone:714-531-8080
Mailing Address - Fax:714-531-9090
Practice Address - Street 1:646 S HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-1384
Practice Address - Country:US
Practice Address - Phone:714-531-8080
Practice Address - Fax:714-531-9090
Is Sole Proprietor?:No
Enumeration Date:2011-09-30
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57832183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist