Provider Demographics
NPI:1508941022
Name:NGUYEN, VUONG Q (PHARMD)
Entity Type:Individual
Prefix:
First Name:VUONG
Middle Name:Q
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 COMO DR
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95337-8471
Mailing Address - Country:US
Mailing Address - Phone:209-406-9944
Mailing Address - Fax:209-825-3617
Practice Address - Street 1:1777 W YOSEMITE AVE
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95337-5187
Practice Address - Country:US
Practice Address - Phone:209-406-9944
Practice Address - Fax:209-825-3617
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 467191835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology