Provider Demographics
NPI:1417626789
Name:NGUY, THIEN PHU
Entity Type:Individual
Prefix:
First Name:THIEN PHU
Middle Name:
Last Name:NGUY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6546 SE ROYCE CT
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-3687
Mailing Address - Country:US
Mailing Address - Phone:971-506-3374
Mailing Address - Fax:
Practice Address - Street 1:16390 BOONES FERRY RD
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-4262
Practice Address - Country:US
Practice Address - Phone:503-636-5697
Practice Address - Fax:503-699-7998
Is Sole Proprietor?:No
Enumeration Date:2021-09-09
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORCPT-0009341183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician