Provider Demographics
NPI:1346224789
Name:NGUYEN, JOHN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1906 VISTA DEL LAGO DR.
Mailing Address - Street 2:SUITE G
Mailing Address - City:VALLEY SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:95252
Mailing Address - Country:US
Mailing Address - Phone:209-920-3299
Mailing Address - Fax:209-920-3391
Practice Address - Street 1:1906 VISTA DEL LAGO DR.
Practice Address - Street 2:SUITE G
Practice Address - City:VALLEY SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:95252
Practice Address - Country:US
Practice Address - Phone:209-920-3299
Practice Address - Fax:209-920-3391
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50960183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA50960OtherCALIFORNIA BOARD OF PHARMACY