Provider Demographics
NPI:1225400617
Name:NGUYEN, NGAN (RPH)
Entity Type:Individual
Prefix:
First Name:NGAN
Middle Name:
Last Name: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 1:2662 DEL MAR HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-3100
Mailing Address - Country:US
Mailing Address - Phone:858-481-8601
Mailing Address - Fax:858-259-9652
Practice Address - Street 1:2662 DEL MAR HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-3100
Practice Address - Country:US
Practice Address - Phone:858-481-8601
Practice Address - Fax:858-259-9652
Is Sole Proprietor?:No
Enumeration Date:2015-10-23
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55809183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist