Provider Demographics
NPI:1376901801
Name:NGUYEN, SANDY MAI TRANG (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SANDY
Middle Name:MAI TRANG
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:SANDY
Other - Middle Name:MAI TRANG
Other - Last Name:HOANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:15642 SAND CANYON AVE
Mailing Address - Street 2:#50061
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92619-5478
Mailing Address - Country:US
Mailing Address - Phone:949-788-9990
Mailing Address - Fax:949-336-6460
Practice Address - Street 1:113 WATERWORKS WAY
Practice Address - Street 2:#160A
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3167
Practice Address - Country:US
Practice Address - Phone:949-788-9990
Practice Address - Fax:949-336-6460
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-28
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58664183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist