Provider Demographics
NPI:1417691981
Name:NGUYEN, DU PHUONG THI (RPH)
Entity Type:Individual
Prefix:
First Name:DU PHUONG
Middle Name:THI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11060 LYNN LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-5641
Mailing Address - Country:US
Mailing Address - Phone:727-642-6307
Mailing Address - Fax:
Practice Address - Street 1:8811 STATE ROAD 52 STE 11
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-6751
Practice Address - Country:US
Practice Address - Phone:727-233-9908
Practice Address - Fax:727-233-9910
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-21
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS33566183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist