Provider Demographics
NPI:1518941426
Name:NGUYEN, THANH VIET (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:THANH
Middle Name:VIET
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 1:2164 BELVEDERE CIR
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-3420
Mailing Address - Country:US
Mailing Address - Phone:916-773-1607
Mailing Address - Fax:
Practice Address - Street 1:19660 STATE HIGHWAY 88
Practice Address - Street 2:
Practice Address - City:PINE GROVE
Practice Address - State:CA
Practice Address - Zip Code:95665-9458
Practice Address - Country:US
Practice Address - Phone:209-296-8777
Practice Address - Fax:209-296-8778
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52589183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist