Provider Demographics
NPI:1215020631
Name:MAI NGUYEN, LAN X (RPH)
Entity Type:Individual
Prefix:MRS
First Name:LAN
Middle Name:X
Last Name:MAI NGUYEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16641 SW 153RD PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33187-0811
Mailing Address - Country:US
Mailing Address - Phone:305-235-0449
Mailing Address - Fax:305-235-0449
Practice Address - Street 1:18300 SW 137TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-6482
Practice Address - Country:US
Practice Address - Phone:305-234-9411
Practice Address - Fax:305-234-9942
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 25303183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1083702OtherNABP