Provider Demographics
NPI:1275044927
Name:NGUYEN, ANDREW TAI (RPH)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:TAI
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 GLENWOOD CIR APT 171
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-4708
Mailing Address - Country:US
Mailing Address - Phone:402-480-1571
Mailing Address - Fax:
Practice Address - Street 1:815 CANYON DEL REY BLVD
Practice Address - Street 2:
Practice Address - City:DEL REY OAKS
Practice Address - State:CA
Practice Address - Zip Code:93940-5525
Practice Address - Country:US
Practice Address - Phone:831-393-2104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-21
Last Update Date:2017-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA77704183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist