Provider Demographics
NPI:1467071878
Name:TRAN NGUYEN, PHUONG (PHARMD)
Entity Type:Individual
Prefix:
First Name:PHUONG
Middle Name:
Last Name:TRAN 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:PO BOX 31
Mailing Address - Street 2:
Mailing Address - City:KEAMS CANYON
Mailing Address - State:AZ
Mailing Address - Zip Code:86034-0031
Mailing Address - Country:US
Mailing Address - Phone:928-737-6195
Mailing Address - Fax:
Practice Address - Street 1:HWY 264 MP 388
Practice Address - Street 2:HOPI HEALTH CARE CENTER
Practice Address - City:POLACCA
Practice Address - State:AZ
Practice Address - Zip Code:86042
Practice Address - Country:US
Practice Address - Phone:928-737-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-15
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26599183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist