Provider Demographics
NPI:1437434404
Name:NGHIEM, MAI PHUONG (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:MAI
Middle Name:PHUONG
Last Name:NGHIEM
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 1:6155 EL CAJON BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-3915
Mailing Address - Country:US
Mailing Address - Phone:619-583-4160
Mailing Address - Fax:619-583-1534
Practice Address - Street 1:6155 EL CAJON BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-3915
Practice Address - Country:US
Practice Address - Phone:619-583-4160
Practice Address - Fax:619-583-1534
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH47332183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist