Provider Demographics
NPI:1215584842
Name:NGUYEN, JOSEPH PHUC XUAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:PHUC XUAN
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 RANCHO MESA CT
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-8986
Mailing Address - Country:US
Mailing Address - Phone:209-613-4618
Mailing Address - Fax:
Practice Address - Street 1:474 WINTON PKWY
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:CA
Practice Address - Zip Code:95334-9809
Practice Address - Country:US
Practice Address - Phone:209-394-6785
Practice Address - Fax:209-394-6790
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-19
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60522183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty