Provider Demographics
NPI:1407288517
Name:NGUYEN, RYAN LONG (PHARMD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:LONG
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 1:12574 LIMONITE AVE
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:91752-3684
Mailing Address - Country:US
Mailing Address - Phone:515-200-1879
Mailing Address - Fax:
Practice Address - Street 1:12574 LIMONITE AVE
Practice Address - Street 2:
Practice Address - City:EASTVALE
Practice Address - State:CA
Practice Address - Zip Code:91752-3684
Practice Address - Country:US
Practice Address - Phone:951-520-0187
Practice Address - Fax:951-520-0386
Is Sole Proprietor?:No
Enumeration Date:2013-07-31
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH72476183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist