Provider Demographics
NPI:1386678654
Name:NGUYEN, TRAM THI-PHUONG (PHARMACIST)
Entity Type:Individual
Prefix:MISS
First Name:TRAM
Middle Name:THI-PHUONG
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:MISS
Other - First Name:TRAM
Other - Middle Name:THI-PHUONG
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:332 MANILLA DR
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-5111
Mailing Address - Country:US
Mailing Address - Phone:801-582-1565
Mailing Address - Fax:801-584-2530
Practice Address - Street 1:500 FOOTHILL BLVD
Practice Address - Street 2:OP119
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84148-0001
Practice Address - Country:US
Practice Address - Phone:801-582-1565
Practice Address - Fax:801-584-2530
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14995183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist