Provider Demographics
NPI:1386016897
Name:NGUYEN, TRUONG (PHARMD)
Entity Type:Individual
Prefix:
First Name:TRUONG
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 1:42150 JACKSON ST BLDG A
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92203-9763
Mailing Address - Country:US
Mailing Address - Phone:760-347-0326
Mailing Address - Fax:760-775-9846
Practice Address - Street 1:42150 JACKSON ST BLDG A
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92203-9763
Practice Address - Country:US
Practice Address - Phone:760-347-0326
Practice Address - Fax:760-775-9846
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-22
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65429183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist