Provider Demographics
NPI:1467851428
Name:NGUYEN, KIM PHUONG THI (PHARMD)
Entity Type:Individual
Prefix:
First Name:KIM PHUONG
Middle Name:THI
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 1:144 W 134TH ST
Mailing Address - Street 2:
Mailing Address - City:CUT OFF
Mailing Address - State:LA
Mailing Address - Zip Code:70345-4155
Mailing Address - Country:US
Mailing Address - Phone:985-325-9750
Mailing Address - Fax:985-325-9751
Practice Address - Street 1:144 W 134TH ST
Practice Address - Street 2:
Practice Address - City:CUT OFF
Practice Address - State:LA
Practice Address - Zip Code:70345-4155
Practice Address - Country:US
Practice Address - Phone:985-325-9750
Practice Address - Fax:985-325-9751
Is Sole Proprietor?:No
Enumeration Date:2014-08-15
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA17974183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist