Provider Demographics
NPI:1376131367
Name:NGUYEN, ANNE NGOCANH
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:NGOCANH
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6902 CHAPEL MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-3833
Mailing Address - Country:US
Mailing Address - Phone:330-631-4391
Mailing Address - Fax:
Practice Address - Street 1:2425 BROADWAY ST # J
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77550-4410
Practice Address - Country:US
Practice Address - Phone:409-763-3444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51767183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty