Provider Demographics
NPI:1356004170
Name:NGUYEN, MIMI HOANG (PHARMD)
Entity Type:Individual
Prefix:
First Name:MIMI
Middle Name:HOANG
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MIMI
Other - Middle Name:
Other - Last Name:NGUYEN-FOTH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:9400 192ND AVE E
Mailing Address - Street 2:
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391-8564
Mailing Address - Country:US
Mailing Address - Phone:253-862-6401
Mailing Address - Fax:
Practice Address - Street 1:9400 192ND AVE E
Practice Address - Street 2:
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-8564
Practice Address - Country:US
Practice Address - Phone:253-299-3565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-19
Last Update Date:2022-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0018600183500000X
WA61215104183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist