Provider Demographics
NPI:1396046058
Name:NGUYEN, THANH T (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:THANH
Middle Name:T
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12318 15TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-4820
Mailing Address - Country:US
Mailing Address - Phone:206-306-0508
Mailing Address - Fax:
Practice Address - Street 1:12318 15TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-4820
Practice Address - Country:US
Practice Address - Phone:206-306-0508
Practice Address - Fax:206-306-0513
Is Sole Proprietor?:No
Enumeration Date:2010-11-12
Last Update Date:2011-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00013004183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist