Provider Demographics
NPI:1295002194
Name:NGUYEN, TRUC VAN (RPH)
Entity Type:Individual
Prefix:
First Name:TRUC
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 1:901 22ND AVE S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-2933
Mailing Address - Country:US
Mailing Address - Phone:727-896-4414
Mailing Address - Fax:727-896-4167
Practice Address - Street 1:901 22ND AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-2933
Practice Address - Country:US
Practice Address - Phone:727-896-4414
Practice Address - Fax:727-896-4167
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-19
Last Update Date:2011-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS34742183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist