Provider Demographics
NPI:1497039317
Name:NGUYEN, THU HA (PHARMD)
Entity Type:Individual
Prefix:
First Name:THU
Middle Name:HA
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 1:2115 US HIGHWAY 60 STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:AZ
Mailing Address - Zip Code:85539-8744
Mailing Address - Country:US
Mailing Address - Phone:928-425-3276
Mailing Address - Fax:
Practice Address - Street 1:2115 US HIGHWAY 60 STE 200
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:AZ
Practice Address - Zip Code:85539-8744
Practice Address - Country:US
Practice Address - Phone:928-425-3276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-11
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20140183500000X
VA0202210554183500000X
AZS018595183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist