Provider Demographics
NPI:1275816290
Name:NGUYEN, PHUONG Q (PHARMD)
Entity Type:Individual
Prefix:
First Name:PHUONG
Middle Name:Q
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:4905 E. IRLO BRONSON MEMORIAL HWY.
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34771
Mailing Address - Country:US
Mailing Address - Phone:407-891-8371
Mailing Address - Fax:407-891-9579
Practice Address - Street 1:4905 E IRLO BRONSON MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34771-8724
Practice Address - Country:US
Practice Address - Phone:407-891-8371
Practice Address - Fax:407-891-9579
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS41739183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist