Provider Demographics
NPI:1518369685
Name:NGUYEN, ELAINE THANH
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:THANH
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 1:3802 CEDAR SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-4149
Mailing Address - Country:US
Mailing Address - Phone:214-443-5160
Mailing Address - Fax:214-443-0741
Practice Address - Street 1:3802 CEDAR SPRINGS RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-4149
Practice Address - Country:US
Practice Address - Phone:214-443-5160
Practice Address - Fax:214-443-0741
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-20
Last Update Date:2022-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX55114183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist