Provider Demographics
NPI:1477195022
Name:NGUYEN, ALLEN QUOC (PHARMD)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:QUOC
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7724 SE 120TH PL
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-5077
Mailing Address - Country:US
Mailing Address - Phone:503-784-4083
Mailing Address - Fax:
Practice Address - Street 1:621 MAIN ST
Practice Address - Street 2:
Practice Address - City:SWEET HOME
Practice Address - State:OR
Practice Address - Zip Code:97386-3339
Practice Address - Country:US
Practice Address - Phone:541-367-6777
Practice Address - Fax:541-367-6500
Is Sole Proprietor?:No
Enumeration Date:2019-10-15
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0017451183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist