Provider Demographics
NPI:1316210354
Name:NGUYEN, PHUC TAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:PHUC
Middle Name:TAN
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:PAUL
Other - Middle Name:
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:404 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BARSTOW
Mailing Address - State:CA
Mailing Address - Zip Code:92311-2326
Mailing Address - Country:US
Mailing Address - Phone:760-256-2726
Mailing Address - Fax:760-256-3199
Practice Address - Street 1:404 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BARSTOW
Practice Address - State:CA
Practice Address - Zip Code:92311-2326
Practice Address - Country:US
Practice Address - Phone:760-256-2726
Practice Address - Fax:760-256-3199
Is Sole Proprietor?:No
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52915183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist