Provider Demographics
NPI:1437432853
Name:NGUYEN, THAO PHUONG (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:THAO
Middle Name:PHUONG
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 1:20 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-5037
Mailing Address - Country:US
Mailing Address - Phone:401-765-2581
Mailing Address - Fax:
Practice Address - Street 1:333 ATWELLS AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-1489
Practice Address - Country:US
Practice Address - Phone:401-276-8301
Practice Address - Fax:401-276-8307
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRPH04620183500000X
MAPH26904183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist