Provider Demographics
NPI:1407443294
Name:NGUYEN, KEVIN THAI (PHARMD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:THAI
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 1:6062 CEDARDALE CT
Mailing Address - Street 2:
Mailing Address - City:WATAUGA
Mailing Address - State:TX
Mailing Address - Zip Code:76148-2723
Mailing Address - Country:US
Mailing Address - Phone:817-266-4068
Mailing Address - Fax:
Practice Address - Street 1:7220 BLUE MOUND RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76131-4802
Practice Address - Country:US
Practice Address - Phone:817-847-7329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66425183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist