Provider Demographics
NPI:1407456890
Name:NGUYEN, THY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:THY
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21101 MCGUIRE RD
Mailing Address - Street 2:
Mailing Address - City:HARVARD
Mailing Address - State:IL
Mailing Address - Zip Code:60033-8358
Mailing Address - Country:US
Mailing Address - Phone:815-943-7459
Mailing Address - Fax:815-943-7949
Practice Address - Street 1:21101 MCGUIRE RD
Practice Address - Street 2:
Practice Address - City:HARVARD
Practice Address - State:IL
Practice Address - Zip Code:60033-8358
Practice Address - Country:US
Practice Address - Phone:815-943-7459
Practice Address - Fax:815-943-7949
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051298857183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist