Provider Demographics
NPI:1508461468
Name:NGUYEN, SUONG-NGUYET MAI
Entity Type:Individual
Prefix:
First Name:SUONG-NGUYET
Middle Name:MAI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 GERMAIN AVE
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-7128
Mailing Address - Country:US
Mailing Address - Phone:781-901-2299
Mailing Address - Fax:
Practice Address - Street 1:405 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-1503
Practice Address - Country:US
Practice Address - Phone:781-749-1163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH232627183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist