Provider Demographics
NPI:1407131642
Name:NGUYEN, PAUL (PHARMD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:PAUL MINH
Other - Middle Name:DUY
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:2345 FENTON PKWY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4743
Mailing Address - Country:US
Mailing Address - Phone:619-358-4002
Mailing Address - Fax:619-358-4009
Practice Address - Street 1:2345 FENTON PKWY
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4743
Practice Address - Country:US
Practice Address - Phone:619-358-4002
Practice Address - Fax:619-358-4009
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-19
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA624031835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist