Provider Demographics
NPI:1285655258
Name:TUAN NGUYEN
Entity Type:Organization
Organization Name:TUAN NGUYEN
Other - Org Name:MAI TRAM PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:TUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-441-2672
Mailing Address - Street 1:512 ELLIS ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-8103
Mailing Address - Country:US
Mailing Address - Phone:415-441-2672
Mailing Address - Fax:415-441-2763
Practice Address - Street 1:512 ELLIS ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-8103
Practice Address - Country:US
Practice Address - Phone:415-441-2672
Practice Address - Fax:415-441-2763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY405683336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0510885OtherNCPDP PROVIDER IDENTIFICATION NUMBER
CAPHA405680Medicaid
CAPHA405680Medicaid