Provider Demographics
NPI:1487631008
Name:NGUYEN, JENNA OANH (PHARMACY TECHNICIAN)
Entity Type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:OANH
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PHARMACY TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22833 BOTHELL EVERETT HWY
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-9547
Mailing Address - Country:US
Mailing Address - Phone:425-481-7810
Mailing Address - Fax:425-485-9179
Practice Address - Street 1:22833 BOTHELL EVERETT HWY
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-9385
Practice Address - Country:US
Practice Address - Phone:425-481-7810
Practice Address - Fax:425-485-9179
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA00056408183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAVA00056408OtherPHARM. TECH. LICENSE