Provider Demographics
NPI:1497911960
Name:NGUYEN, PHUONG (MS RPH)
Entity Type:Individual
Prefix:MR
First Name:PHUONG
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MS RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1716 SUNTERRO
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78727-3431
Mailing Address - Country:US
Mailing Address - Phone:512-750-4760
Mailing Address - Fax:
Practice Address - Street 1:7302 LOUIS PASTEUR DR STE 105
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4513
Practice Address - Country:US
Practice Address - Phone:210-231-0383
Practice Address - Fax:210-231-0462
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39650183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist