Provider Demographics
NPI:1326335936
Name:NGUYEN, KALENA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KALENA
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 PARK AVE
Mailing Address - Street 2:T-2151
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-2702
Mailing Address - Country:US
Mailing Address - Phone:714-361-2101
Mailing Address - Fax:714-361-2101
Practice Address - Street 1:2300 PARK AVE
Practice Address - Street 2:T-2151
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92782-2702
Practice Address - Country:US
Practice Address - Phone:714-361-2101
Practice Address - Fax:714-361-2101
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-03
Last Update Date:2011-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61360183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist