Provider Demographics
NPI:1306218490
Name:NGUYEN, KHOA A (RPH)
Entity Type:Individual
Prefix:
First Name:KHOA
Middle Name:A
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 1:7578 BELGIAN LION ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-5302
Mailing Address - Country:US
Mailing Address - Phone:702-635-7031
Mailing Address - Fax:
Practice Address - Street 1:10440 W CHEYENNE AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-8712
Practice Address - Country:US
Practice Address - Phone:702-233-6085
Practice Address - Fax:702-233-6989
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV16215183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist