Provider Demographics
NPI:1417001652
Name:NGUYEN, MAI THUY (PHARMD)
Entity Type:Individual
Prefix:
First Name:MAI
Middle Name:THUY
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 1:13062 ANSELL CT
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-3414
Mailing Address - Country:US
Mailing Address - Phone:714-791-8609
Mailing Address - Fax:
Practice Address - Street 1:11190 WARNER AVE STE 111
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4028
Practice Address - Country:US
Practice Address - Phone:717-979-3784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56742183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist