Provider Demographics
NPI:1235563016
Name:NGUYEN, BIRDIE KIET (PHARMD)
Entity Type:Individual
Prefix:
First Name:BIRDIE
Middle Name:KIET
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 1:8101 COSUMNES RIVER BLVD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-5415
Mailing Address - Country:US
Mailing Address - Phone:916-525-3576
Mailing Address - Fax:
Practice Address - Street 1:8101 COSUMNES RIVER BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-5415
Practice Address - Country:US
Practice Address - Phone:916-525-3576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA69525183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist