Provider Demographics
NPI:1417679242
Name:NGUYEN, HOANG MY (PHARMD)
Entity Type:Individual
Prefix:
First Name:HOANG
Middle Name:MY
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 1:1602 N KING ST APT J3
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706-3263
Mailing Address - Country:US
Mailing Address - Phone:714-907-2983
Mailing Address - Fax:
Practice Address - Street 1:24382 MUIRLANDS BLVD
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-3679
Practice Address - Country:US
Practice Address - Phone:949-598-9088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86759183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist