Provider Demographics
NPI:1417300625
Name:NGUYEN, MAISIE MY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MAISIE
Middle Name:MY
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:BAOCHAU
Other - Middle Name:MY
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2960 CHAMPION WAY
Mailing Address - Street 2:APT 712
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782
Mailing Address - Country:US
Mailing Address - Phone:323-834-9685
Mailing Address - Fax:
Practice Address - Street 1:2960 CHAMPION WAY
Practice Address - Street 2:APT 712
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92782-1234
Practice Address - Country:US
Practice Address - Phone:323-834-9685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-22
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73894183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist