Provider Demographics
NPI:1528409588
Name:NGUYEN, PHUONG ANH THI (PHARMD)
Entity Type:Individual
Prefix:
First Name:PHUONG ANH
Middle Name:THI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27941 SHEFFIELD
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-2806
Mailing Address - Country:US
Mailing Address - Phone:949-207-8495
Mailing Address - Fax:
Practice Address - Street 1:27941 SHEFFIELD
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92692-2806
Practice Address - Country:US
Practice Address - Phone:949-207-8495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-08
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61083183500000X
TX48308183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist