Provider Demographics
NPI:1306219142
Name:NGUYEN, CONNIE (PHARM D)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8601 S SEPULVEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-4001
Mailing Address - Country:US
Mailing Address - Phone:310-645-6770
Mailing Address - Fax:310-645-1052
Practice Address - Street 1:8601 S SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-4001
Practice Address - Country:US
Practice Address - Phone:310-645-6770
Practice Address - Fax:310-645-1052
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64204183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist