Provider Demographics
NPI:1497065148
Name:NGUYEN, ERIC NGOC
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:NGOC
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:ERIC
Other - Middle Name:NGOC
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:204 ODYSSEY LN
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-3438
Mailing Address - Country:US
Mailing Address - Phone:817-975-9481
Mailing Address - Fax:817-453-6252
Practice Address - Street 1:2962 S LONGHORN DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:TX
Practice Address - Zip Code:75134-2118
Practice Address - Country:US
Practice Address - Phone:972-228-5645
Practice Address - Fax:972-228-5646
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38760183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist