Provider Demographics
NPI:1477926335
Name:NGUYEN, JENNY HAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:HAN
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 1:228 N HARBOR BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92703-3337
Mailing Address - Country:US
Mailing Address - Phone:714-554-7211
Mailing Address - Fax:714-554-6014
Practice Address - Street 1:228 N HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92703-3337
Practice Address - Country:US
Practice Address - Phone:714-554-7211
Practice Address - Fax:714-554-6014
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-01
Last Update Date:2015-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH51030183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist