Provider Demographics
NPI:1346994613
Name:NGUYEN, AUDREY P (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:P
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 1:22831 ANGELIQUE DR
Mailing Address - Street 2:
Mailing Address - City:BRAMBLETON
Mailing Address - State:VA
Mailing Address - Zip Code:20148-5649
Mailing Address - Country:US
Mailing Address - Phone:703-727-0355
Mailing Address - Fax:
Practice Address - Street 1:101 CROSSTRAIL BLVD SE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-4660
Practice Address - Country:US
Practice Address - Phone:703-669-2255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2020204295183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist