Provider Demographics
NPI:1417430539
Name:NGUYEN, MICHELLE HT (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:HT
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 N BROOKHURST ST STE 123
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-5618
Mailing Address - Country:US
Mailing Address - Phone:714-947-4770
Mailing Address - Fax:714-947-4768
Practice Address - Street 1:421 N BROOKHURST ST STE 123
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-5618
Practice Address - Country:US
Practice Address - Phone:714-947-4770
Practice Address - Fax:714-947-4768
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61713183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA61713OtherPHARMACIST LICENSE