Provider Demographics
NPI:1417239203
Name:NGUYEN, PETER K (PHARMD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:K
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 1:29105 VALLEY CENTER RD STE 100
Mailing Address - Street 2:
Mailing Address - City:VALLEY CENTER
Mailing Address - State:CA
Mailing Address - Zip Code:92082-6588
Mailing Address - Country:US
Mailing Address - Phone:760-749-1156
Mailing Address - Fax:760-749-1921
Practice Address - Street 1:29105 VALLEY CENTER RD STE 100
Practice Address - Street 2:
Practice Address - City:VALLEY CENTER
Practice Address - State:CA
Practice Address - Zip Code:92082-6588
Practice Address - Country:US
Practice Address - Phone:760-749-1156
Practice Address - Fax:760-749-1921
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55301183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist