Provider Demographics
NPI:1326032517
Name:GISELE NGUYEN INC
Entity Type:Organization
Organization Name:GISELE NGUYEN INC
Other - Org Name:NATICO PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:GISELE
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:714-534-1020
Mailing Address - Street 1:10212 WESTMINSTER AVE
Mailing Address - Street 2:STE 109
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843
Mailing Address - Country:US
Mailing Address - Phone:714-534-1020
Mailing Address - Fax:714-534-1024
Practice Address - Street 1:10212 WESTMINSTER AVE
Practice Address - Street 2:STE 109
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843
Practice Address - Country:US
Practice Address - Phone:714-534-1020
Practice Address - Fax:714-534-1024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-02
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY 502993336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY 50299OtherRETAIL PHARMACY PERMIT
0578560OtherNCPDP PROVIDER IDENTIFICATION NUMBER
CAPHY 50299OtherRETAIL PHARMACY PERMIT