Provider Demographics
NPI:1275051484
Name:NGUYEN, DUC VAN (RPH)
Entity Type:Individual
Prefix:
First Name:DUC
Middle Name:VAN
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 1:20307 MOUNTAIN HWY E
Mailing Address - Street 2:
Mailing Address - City:SPANAWAY
Mailing Address - State:WA
Mailing Address - Zip Code:98387-8101
Mailing Address - Country:US
Mailing Address - Phone:253-846-6260
Mailing Address - Fax:
Practice Address - Street 1:20307 MOUNTAIN HWY E
Practice Address - Street 2:
Practice Address - City:SPANAWAY
Practice Address - State:WA
Practice Address - Zip Code:98387-8101
Practice Address - Country:US
Practice Address - Phone:253-846-6260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-07
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60777589183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist