Provider Demographics
NPI:1316228653
Name:NGUYEN, TAI T (RPH)
Entity Type:Individual
Prefix:MR
First Name:TAI
Middle Name:T
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 1:46 CREST DR
Mailing Address - Street 2:
Mailing Address - City:ENGLISHTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-8257
Mailing Address - Country:US
Mailing Address - Phone:732-972-9885
Mailing Address - Fax:
Practice Address - Street 1:520 CONVERY BLVD
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-3021
Practice Address - Country:US
Practice Address - Phone:732-826-9222
Practice Address - Fax:732-293-0177
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02248300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist